Provider Demographics
NPI:1124038104
Name:WILEY, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WILEY
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 1:1850 HICKORY ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2334
Mailing Address - Country:US
Mailing Address - Phone:325-677-2801
Mailing Address - Fax:325-677-9110
Practice Address - Street 1:1850 HICKORY ST
Practice Address - Street 2:SUITE #102
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2334
Practice Address - Country:US
Practice Address - Phone:325-677-2801
Practice Address - Fax:325-677-9110
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9440208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113394OtherSUPERIOR / CHIP
TX86X084OtherBCBS
TX111645104Medicaid
TX126868100OtherFIRSTCARE - HMO
TX111645104Medicaid
TXTXB118180Medicare PIN