Provider Demographics
NPI:1144393810
Name:ROBERT B DUNDAS MD PA
Entity Type:Organization
Organization Name:ROBERT B DUNDAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:4098-359-3000
Mailing Address - Street 1:810 HOSPITAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4635
Mailing Address - Country:US
Mailing Address - Phone:409-835-9300
Mailing Address - Fax:409-835-9303
Practice Address - Street 1:810 HOSPITAL DR STE 301
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4635
Practice Address - Country:US
Practice Address - Phone:409-835-9300
Practice Address - Fax:409-835-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF52405Medicare UPIN
TX00X659Medicare PIN