Provider Demographics
NPI:1093703902
Name:ROBBINS, BART (DO)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:
Last Name:ROBBINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 CLEAR LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5895
Mailing Address - Country:US
Mailing Address - Phone:817-596-3500
Mailing Address - Fax:817-596-3524
Practice Address - Street 1:1429 CLEAR LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5895
Practice Address - Country:US
Practice Address - Phone:817-596-3500
Practice Address - Fax:817-596-3524
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145483701Medicaid
H42983Medicare UPIN