Healthcare Provider Details

I. General information

NPI: 1174899249
Provider Name (Legal Business Name): ROBERT DEWOLFE MAIR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE B2-140
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

3801 MIRANDA AVE B2-140
PALO ALTO CA
94304-1207
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax: 650-849-0213
Mailing address:
  • Phone: 650-493-5000
  • Fax: 650-849-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA127016
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA127016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: