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NPI Code Detail

MEDICARE: ROBERT WILLIAM WATROUS MD

MEDICARE: ROBERT WILLIAM WATROUS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) PhysicianG81561CA
2207QA0401XAddiction Medicine (Family Medicine) Physician50616CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1022362OTHERCOKAISER COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013084821
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT WILLIAM WATROUS MD
Provider Business Mailing Address
First Line : 250 S G ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92410-3320
Country : US
Telephone Number : 909-382-7100
Fax Number :
Provider Business Practice Location Address
First Line : 250 S G ST
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92410-3320
Country : US
Telephone Number : 909-382-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 11/26/2024

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