Provider Demographics
NPI:1467440073
Name:CLOUD, ROBERT ROYCE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROYCE
Last Name:CLOUD
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 1:3409 WORTH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2029
Mailing Address - Country:US
Mailing Address - Phone:469-800-7600
Mailing Address - Fax:972-788-4971
Practice Address - Street 1:3409 WORTH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2029
Practice Address - Country:US
Practice Address - Phone:469-800-7600
Practice Address - Fax:972-788-4971
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0977174400000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115239907Medicaid
TX115239905Medicaid
TX115239906Medicaid
TX115239905Medicaid
TXTXB112165Medicare PIN
TXTXB112161Medicare PIN
TXTXB112163Medicare PIN