Healthcare Provider Details

I. General information

NPI: 1811057086
Provider Name (Legal Business Name): ROBERT BRANDT FICK, JR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PALO ALTO VA HEALTH CARE SYSTEM 3801 MIRANDA AVENUE, PULMONARY & CCM
PALO ALTO CA
94344
US

IV. Provider business mailing address

240 MIMOSA WAY
PORTOLA VALLEY CA
94028
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-233-0647
  • Fax: 650-496-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG75955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: