Healthcare Provider Details

I. General information

NPI: 1275553893
Provider Name (Legal Business Name): ROBERT MCLEOD P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 OLLER ST STE 101
MENDOTA CA
93640-2382
US

IV. Provider business mailing address

5475 N ANGUS ST APT. 106
FRESNO CA
93710-6151
US

V. Phone/Fax

Practice location:
  • Phone: 559-655-1000
  • Fax: 559-655-7402
Mailing address:
  • Phone: 559-999-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA11207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: