Healthcare Provider Details

I. General information

NPI: 1336217306
Provider Name (Legal Business Name): ROBERT E BELKNAP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 REDWOOD HWY SUITE 375
MILL VALLEY CA
94941-3034
US

IV. Provider business mailing address

655 REDWOOD HWY SUITE 375
MILL VALLEY CA
94941-3034
US

V. Phone/Fax

Practice location:
  • Phone: 415-384-0506
  • Fax:
Mailing address:
  • Phone: 415-384-0506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA24275
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: