Provider Demographics
NPI:1215934948
Name:COMBS, ROBERT LAWSON (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAWSON
Last Name:COMBS
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 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-575-6049
Mailing Address - Fax:707-573-6165
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-573-6166
Practice Address - Fax:707-573-6165
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36515207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G365150Medicaid
CA060062537OtherRAILROAD MEDICARE
CA060062538OtherRAILROAD MEDICARE
CA00G365150OtherBLUE SHIELD OF CALIFORNIA
CA00G365150OtherBLUE SHIELD OF CALIFORNIA
CAA46714Medicare UPIN
CA00G365152Medicare PIN