Bobby Glenn Aycock, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

A44291 Issued in CA

Practice address

1855 San Miguel Dr
Suite 4
Walnut Creek, CA 94596-5279

Phone

(925) 937-8377

Fax

(925) 937-8384

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Robert Glenn Aycock Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063567873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 SAN MIGUEL DR",
            "address_2": "SUITE 4",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965279",
            "telephone_number": "925-937-8377",
            "fax_number": "925-937-8384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 SAN MIGUEL DR",
            "address_2": "SUITE 4",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945965279",
            "telephone_number": "925-937-8377",
            "fax_number": "925-937-8384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYCOCK",
        "first_name": "BOBBY",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A44291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROBERT",
            "last_name": "AYCOCK",
            "middle_name": "GLENN",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Gloria Aviles
• Awcy, LLC (La Casa Via Transitional Care Center)
• Michelle Ayala Romo
• Albert Ayala
• Destiny Ayala
• Alysia Ayoub, MA
• Aysha Ayub, DO
• Nardine Azab, MFT
• Ludy Fiorella Azabache
• Jessica Azer, LMFT

• Plastic Surgery Physician in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.