Provider Demographics
NPI:1033227723
Name:BOLSTER, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:BOLSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 SPOHN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4135
Mailing Address - Country:US
Mailing Address - Phone:361-993-2020
Mailing Address - Fax:361-993-0515
Practice Address - Street 1:5833 SPOHN DR STE 101
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4135
Practice Address - Country:US
Practice Address - Phone:361-993-2020
Practice Address - Fax:361-993-0515
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3102207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030417201Medicaid
TXA82873Medicare UPIN
TX030417201Medicaid