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General NPI Number Information
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NPI Number | 1982700969
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Entity Type | Individual
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Provider Name | ROBERT CHARLES SOUTHMAYD D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 1768 MITCHELL RD STE 301
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City | CERES
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State | CA
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Zip | 95307-2156
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Country | US
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Telephone | 209-353-4838
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Fax |
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Provider Business Mailing Address
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Address Line | 3062 JOSHUA TREE CIR
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City | STOCKTON
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State | CA
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Zip | 95209-3800
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Country | US
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Telephone | 209-244-8101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 5298
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 20A5298
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License Number State | CA
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