Robert Agee, MD
Individual provider Active NPI Specialist · San Pablo, CA
NPI 1811038490 · NPPES record last updated Feb 11, 2008
Key facts
- NPI
- 1811038490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- C40033 (CA)
- Practice address
- 2089 Vale Rd Ste 25
Suite 25
San Pablo, CA 94806-3849 - Phone
- (510) 235-1137
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C40033 | CA | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | C40033 | CA | Yes |
Addresses
Primary practice location
2089 Vale Rd Ste 25
Suite 25
San Pablo, CA 94806-3849
Mailing address
2089 Vale Rd Ste 25
Suite 25
San Pablo, CA 94806-3849
Phone (510) 235-1137
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ73201Z | Medicaid | CA | |
| C40033 | Other | CA | CA LIC |
Other providers in San Pablo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.