Provider Demographics
NPI:1346322104
Name:MANN, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:MANN
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:701 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9164
Practice Address - Country:US
Practice Address - Phone:817-453-5437
Practice Address - Fax:817-453-2714
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5433208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111720204Medicaid
TX137345810OtherCSHCN GROUP
TX76522OtherUHC PIN
TX140442852OtherMEDICAID GROUP
TX4545730OtherCIGNA PIN
TX111720205OtherCSHCN
TXMANRF43476OtherCCHIP PIN
TX00U87ZOtherBCBSTX GRP PIN
00U87ZOtherMEDICARE GROUP
TX159300OtherPHCS PIN
1750369203OtherGRP NPI NUMBER
TX81Y562OtherBCBSTX IND PIN
TX118492100OtherFIRSTCARE PIN
TX1640388OtherFIRSTHEALTH PIN
TX4019464OtherAETNA PIN
8L11393Medicare PIN
TX4019464OtherAETNA PIN