Provider Demographics
NPI:1841378320
Name:WHITSON, ROBERT K (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:WHITSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 DOUGLAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3866
Mailing Address - Country:US
Mailing Address - Phone:916-774-8500
Mailing Address - Fax:
Practice Address - Street 1:3100 DOUGLAS BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3866
Practice Address - Country:US
Practice Address - Phone:916-774-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30314208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G303140Medicaid
A44376Medicare UPIN
CA00G303140Medicaid