Provider Demographics
NPI:1407962277
Name:DALLAS, ROBERT V (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
Last Name:DALLAS
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 861
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580-0861
Mailing Address - Country:US
Mailing Address - Phone:603-823-0012
Mailing Address - Fax:
Practice Address - Street 1:67 TIMBER LN
Practice Address - Street 2:BOX 861
Practice Address - City:FRANCONIA
Practice Address - State:NH
Practice Address - Zip Code:03580-5021
Practice Address - Country:US
Practice Address - Phone:603-823-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH88382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology