Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C29179 | CA |
NPI | 1013082593 |
---|---|
Provider Name | Dr. Robert E Mines JR. |
First Address | Oakland, CA 94608-2811 |
Second Address | Oakland, CA 94608-2811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |