Provider Demographics
NPI:1477601706
Name:REBECCA M. ROBERT, M.D., P.A.
Entity Type:Organization
Organization Name:REBECCA M. ROBERT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-424-3112
Mailing Address - Street 1:1600 W COLLEGE ST
Mailing Address - Street 2:STE 1101
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3580
Mailing Address - Country:US
Mailing Address - Phone:817-424-3112
Mailing Address - Fax:817-488-2820
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:STE 1101
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:817-424-3112
Practice Address - Fax:817-488-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029692301Medicaid
TX029692301Medicaid
00Z408Medicare PIN