Provider Demographics
NPI:1467599613
Name:ROBERT J MAMLOK
Entity Type:Organization
Organization Name:ROBERT J MAMLOK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:MAMLOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-795-4391
Mailing Address - Street 1:5424 19TH ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2162
Mailing Address - Country:US
Mailing Address - Phone:806-795-4391
Mailing Address - Fax:806-796-1354
Practice Address - Street 1:5424 19TH ST
Practice Address - Street 2:SUITE #300
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2162
Practice Address - Country:US
Practice Address - Phone:806-795-4391
Practice Address - Fax:806-796-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0596174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123013801Medicaid
TX614419Medicare PIN
TXE24055Medicare UPIN