Provider Demographics
NPI:1922006188
Name:IZENBERG, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:IZENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:NAVAL MEDICAL CENTER DEPT OF SURGERY
Mailing Address - Street 2:34730 BOB WILSON DR., BLDG 3, 4TH FLOOR
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-3400
Mailing Address - Country:US
Mailing Address - Phone:619-532-7006
Mailing Address - Fax:619-532-7673
Practice Address - Street 1:NAVAL MEDICAL CENTER DEPT OF SURGERY
Practice Address - Street 2:34730 BOB WILSON DR., BLDG 3, 4TH FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-3400
Practice Address - Country:US
Practice Address - Phone:619-532-7006
Practice Address - Fax:619-532-7673
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-01-23
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Provider Licenses
StateLicense IDTaxonomies
CAG 58288208600000X
IDM 9378208600000X
CAG582882086S0102X, 2086S0127X
IDM93782086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36183Medicare UPIN