Provider Demographics
NPI:1366473258
Name:SEPULVEDA, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SEPULVEDA
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 1:901 E 6TH
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6449
Mailing Address - Country:US
Mailing Address - Phone:956-968-9517
Mailing Address - Fax:956-968-9518
Practice Address - Street 1:901 E 6TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4202
Practice Address - Country:US
Practice Address - Phone:956-968-9517
Practice Address - Fax:956-968-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D684Medicare ID - Type Unspecified
TXC21622Medicare UPIN