Provider Demographics
NPI:1265475677
Name:MENNEL, ROBERT GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GARY
Last Name:MENNEL
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1000
Practice Address - Fax:214-370-1026
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6039207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138667402Medicaid
TX138667407Medicaid
TX138667404Medicaid
TX8R1504OtherBLUE CROSS OF TX
TX138667412Medicaid
TX138667414Medicaid
TX138667405Medicaid
TX138667410Medicaid
TX138667403Medicaid
TX138667406Medicaid
TX138667402Medicaid
TX138667403Medicaid
TX138667407Medicaid
B24854Medicare UPIN
TX88247KMedicare PIN
TX823570Medicare PIN
TX8G0694Medicare PIN
TX830001123Medicare PIN