Provider Demographics
NPI:1346216686
Name:BISONNI, ROBERTO SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:SERGIO
Last Name:BISONNI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1804 FM 646 RD W
Mailing Address - Street 2:SUITE J
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-3232
Mailing Address - Country:US
Mailing Address - Phone:281-534-0400
Mailing Address - Fax:281-534-0440
Practice Address - Street 1:1804 FM 646 RD W
Practice Address - Street 2:SUITE J
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3232
Practice Address - Country:US
Practice Address - Phone:281-534-0400
Practice Address - Fax:281-534-0440
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ8916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3127Medicare PIN
TXG11258Medicare UPIN