Provider Demographics
NPI:1588695167
Name:FROSS, ROBIN DELL (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:DELL
Last Name:FROSS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2500 MERCED STREET - SUITE 208
Mailing Address - Street 2:KAISER - PERMANENTE MEDICAL CENTER, DEPARTMENT OF NEPHR
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-454-3167
Mailing Address - Fax:510-454-3163
Practice Address - Street 1:2500 MERCED STREET - SUITE 208
Practice Address - Street 2:KAISER - PERMANENTE MEDICAL CENTER, DEPARTMENT OF NEPHR
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:510-454-3167
Practice Address - Fax:510-454-3163
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-04-30
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Provider Licenses
StateLicense IDTaxonomies
CAG60158174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE64749Medicare UPIN