Provider Demographics
NPI:1003972829
Name:HOSTETTER, ROBIN E (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:E
Last Name:HOSTETTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4207 GARDENDALE ST STE 101B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3142
Mailing Address - Country:US
Mailing Address - Phone:210-615-1626
Mailing Address - Fax:210-615-1636
Practice Address - Street 1:8400 BLANCO RD STE 206
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3055
Practice Address - Country:US
Practice Address - Phone:210-979-9437
Practice Address - Fax:210-979-9839
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK00662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1135527-01Medicaid
TX1135527-01Medicaid