Provider Demographics
NPI:1154479210
Name:FEFERMAN, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:FEFERMAN
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 1:4225 WINGREN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2762
Mailing Address - Country:US
Mailing Address - Phone:214-596-9302
Mailing Address - Fax:214-596-9315
Practice Address - Street 1:4225 WINGREN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2762
Practice Address - Country:US
Practice Address - Phone:214-596-9302
Practice Address - Fax:214-596-9315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4057174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF63841Medicare UPIN