Provider Demographics
NPI:1134107360
Name:GARBACZ, ROBERT T (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:GARBACZ
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 1:5 EUREKA CIR STE D
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2900
Mailing Address - Country:US
Mailing Address - Phone:940-767-3376
Mailing Address - Fax:940-767-1013
Practice Address - Street 1:5 EUREKA CIR STE D
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2900
Practice Address - Country:US
Practice Address - Phone:940-767-3376
Practice Address - Fax:940-767-1013
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8599207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE73458Medicare UPIN
TX613620Medicare PIN