Healthcare Provider Details

I. General information

NPI: 1487757779
Provider Name (Legal Business Name): ROBERT A CHASE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 GOLDEN CENTER DR SUITE D
PLACERVILLE CA
95667-6278
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-344-2000
  • Fax: 530-344-2014
Mailing address:
  • Phone: 530-344-2000
  • Fax: 530-344-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG74828
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG74828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: