Healthcare Provider Details

I. General information

NPI: 1013084821
Provider Name (Legal Business Name): ROBERT WILLIAM WATROUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S G ST
SAN BERNARDINO CA
92410-3320
US

IV. Provider business mailing address

250 S G ST
SAN BERNARDINO CA
92410-3320
US

V. Phone/Fax

Practice location:
  • Phone: 909-382-7100
  • Fax:
Mailing address:
  • Phone: 909-382-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberG81561
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number50616
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: