Provider Demographics
NPI:1598701211
Name:FERRETTI, ROBERT S (M D)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:FERRETTI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:#302
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1712
Mailing Address - Country:US
Mailing Address - Phone:415-925-3521
Mailing Address - Fax:415-461-4971
Practice Address - Street 1:599 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:#302
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1712
Practice Address - Country:US
Practice Address - Phone:415-925-3521
Practice Address - Fax:415-461-4971
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G185120OtherBLUE SHIELD PROVIDER #
CA00G185120Medicaid
CA00G185120OtherBLUE CROSS PROVIDER #
CAA40363Medicare UPIN
CA00G185120Medicaid