Healthcare Provider Details

I. General information

NPI: 1164472536
Provider Name (Legal Business Name): ROBERT I MCCASLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST PSSB SUITE 2100
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

505 ELLIS BLVD APT A5
JEFFERSON CITY MO
65101-2291
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-8249
  • Fax: 916-734-7950
Mailing address:
  • Phone: 858-735-6943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number226294
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number226294
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG79591
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberG79591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: