Provider Demographics
NPI:1881750396
Name:ROBERT J KORENBERG MD
Entity type:Organization
Organization Name:ROBERT J KORENBERG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-335-8638
Mailing Address - Street 1:DEPT 0873
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1821 SOUTH AVE W
Practice Address - Street 2:SUITE 402
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6517
Practice Address - Country:US
Practice Address - Phone:909-335-8638
Practice Address - Fax:909-335-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty