Provider Demographics
NPI:1326286113
Name:ROBERT T. ZWERNEMANN, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT T. ZWERNEMANN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZWERNEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-870-2258
Mailing Address - Street 1:851 W. TERRELL AVE.
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3161
Mailing Address - Country:US
Mailing Address - Phone:817-870-2258
Mailing Address - Fax:817-916-5811
Practice Address - Street 1:851 W. TERRELL AVE.
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3161
Practice Address - Country:US
Practice Address - Phone:817-870-2258
Practice Address - Fax:817-916-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0508207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038870402Medicaid
TX00251WMedicare PIN
TXG93647Medicare UPIN