Basic Information
| Provider Information | |||||||||
| NPI: | 1114998390 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HOUTS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 707 | ||||||||
| Address2: | BILLING OFFICE, PLACERVILLE RADIOLOGY MEDICAL GROUP | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956670707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306261166 | ||||||||
| FaxNumber: | 5306263826 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 MARSHALL WAY | ||||||||
| Address2: | MARSHALL MEDICAL CENTER | ||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306221441 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 09/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | A21723 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0203X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0204X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0205X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085U0001X | A21723 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | GR0053460 | 05 | CA | MEDICAID | 300027182 | 01 | RAILROAD MEDICARE | OTHER |