Provider Demographics
NPI:1417907486
Name:MELTZER, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:MELTZER
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 1:1604 HOSPITAL PKWY
Mailing Address - Street 2:# 208
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6986
Mailing Address - Country:US
Mailing Address - Phone:817-540-2544
Mailing Address - Fax:817-391-0105
Practice Address - Street 1:1604 HOSPITAL PKWY
Practice Address - Street 2:# 208
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6986
Practice Address - Country:US
Practice Address - Phone:817-540-2544
Practice Address - Fax:817-391-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00815FMedicare PIN
TXC19278Medicare UPIN