Provider Demographics
NPI:1215937933
Name:DAVIES, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:DAVIES
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 1:112 LA CASA VIA
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3091
Mailing Address - Country:US
Mailing Address - Phone:925-944-0351
Mailing Address - Fax:925-944-1957
Practice Address - Street 1:112 LA CASA VIA
Practice Address - Street 2:SUITE 210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3091
Practice Address - Country:US
Practice Address - Phone:925-944-0351
Practice Address - Fax:925-944-1957
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42189207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP2044OtherMEDICARE RAILROAD
CAGR0020610Medicaid
E40593Medicare UPIN
OOA421890Medicare ID - Type Unspecified
00A42190Medicare ID - Type Unspecified
CP2044OtherMEDICARE RAILROAD