Provider Demographics
NPI:1275544694
Name:DEMARTINI, ROBERT V (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:V
Last Name:DEMARTINI
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 1:105 GREENHILL TRL S
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5608
Mailing Address - Country:US
Mailing Address - Phone:972-679-3982
Mailing Address - Fax:
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 490
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-481-1511
Practice Address - Fax:817-442-8243
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042463202Medicaid
TX110241713OtherRAILROAD MEDICARE
TX042463202Medicaid
TXE45978Medicare UPIN