Provider Demographics
NPI:1366493017
Name:STEVENSON, ROBERT N (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:N
Last Name:STEVENSON
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 1:1224 GABRIEL LN
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1636
Mailing Address - Country:US
Mailing Address - Phone:817-999-4863
Mailing Address - Fax:817-731-5313
Practice Address - Street 1:1224 GABRIEL LN
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1636
Practice Address - Country:US
Practice Address - Phone:817-999-4863
Practice Address - Fax:817-731-5313
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2878207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138803516Medicaid
C22272Medicare UPIN
TXTXB166277Medicare PIN
P00292275Medicare ID - Type UnspecifiedRAIL ROAD
TX138803516Medicaid