Healthcare Provider Details

I. General information

NPI: 1013082593
Provider Name (Legal Business Name): ROBERT E MINES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 MARKET ST
OAKLAND CA
94608-2811
US

IV. Provider business mailing address

5715 MARKET ST
OAKLAND CA
94608-2811
US

V. Phone/Fax

Practice location:
  • Phone: 510-652-5161
  • Fax: 510-652-4225
Mailing address:
  • Phone: 510-652-5161
  • Fax: 510-652-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC29179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: