Provider Demographics
NPI:1235193848
Name:FALCONER, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:FALCONER
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 1:123 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8510
Mailing Address - Country:US
Mailing Address - Phone:903-729-6010
Mailing Address - Fax:903-729-6886
Practice Address - Street 1:123 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8510
Practice Address - Country:US
Practice Address - Phone:903-729-6010
Practice Address - Fax:903-729-6886
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4830208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154186401Medicaid
TX8A0244Medicare PIN
TX154186401Medicaid