Provider Demographics
NPI:1134105661
Name:PETRAS, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:PETRAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8018
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:7730 FIRST PL
Practice Address - Street 2:SUITE A
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6719
Practice Address - Country:US
Practice Address - Phone:800-331-7546
Practice Address - Fax:440-703-2155
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2013-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35046333P207ZP0102X
NY235446-1207ZP0102X
NJ25MA07940700207ZP0102X
AZ33830207ZP0102X
MI4301084916207ZP0102X
PAMD421441207ZP0102X
FLME92774207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E76439Medicare UPIN