Provider Demographics
NPI:1982763116
Name:ROBERT F METH MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT F METH MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:METH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-1377
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:STE 810
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-556-1377
Mailing Address - Fax:310-556-1650
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:STE 810
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-556-1377
Practice Address - Fax:310-556-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A23773207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21472Medicare PIN