Healthcare Provider Details

I. General information

NPI: 1649221060
Provider Name (Legal Business Name): ROBERT C DEERE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11480 BROOKSHIRE AVE SUITE 111
DOWNEY CA
90241-5010
US

IV. Provider business mailing address

11480 BROOKSHIRE AVE SUITE 111
DOWNEY CA
90241-5010
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-1651
  • Fax: 562-904-1656
Mailing address:
  • Phone: 562-904-1651
  • Fax: 562-904-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG54147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: