Provider Demographics
NPI:1336658236
Name:ROBERT D. MENZIES, MD, PLLC
Entity Type:Organization
Organization Name:ROBERT D. MENZIES, MD, PLLC
Other - Org Name:SOUTHWEST SPORTS AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPLECHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-294-0934
Mailing Address - Street 1:7148 TRAIL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1969
Mailing Address - Country:US
Mailing Address - Phone:817-294-0934
Mailing Address - Fax:817-769-2227
Practice Address - Street 1:1307 8TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4141
Practice Address - Country:US
Practice Address - Phone:817-953-3458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT D. MENZIES, MD.,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3643208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty