Provider Demographics
NPI:1023198637
Name:TYLER KIDNEY DOCTORS PA
Entity Type:Organization
Organization Name:TYLER KIDNEY DOCTORS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOBROWOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-594-2293
Mailing Address - Street 1:PO BOX 132506
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-2506
Mailing Address - Country:US
Mailing Address - Phone:903-594-2293
Mailing Address - Fax:903-566-0167
Practice Address - Street 1:700 OLYMPIC PLAZA CIR
Practice Address - Street 2:912
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1951
Practice Address - Country:US
Practice Address - Phone:903-594-2293
Practice Address - Fax:903-848-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8518207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0032NCOtherBCBS GROUP
TX00812ZMedicare PIN