Healthcare Provider Details

I. General information

NPI: 1588774863
Provider Name (Legal Business Name): ROBERT ERIC SOLOMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 191 AND HOSPITAL ROAD
CHINLE AZ
86503
US

IV. Provider business mailing address

PO BOX PH
CHINLE AZ
86503-8000
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7166
  • Fax: 928-674-7705
Mailing address:
  • Phone: 928-674-7166
  • Fax: 928-674-7705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9401049
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: