Provider Demographics
NPI:1497780118
Name:INZER, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:INZER
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 1:817 LONGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-9062
Mailing Address - Country:US
Mailing Address - Phone:214-802-1041
Mailing Address - Fax:601-299-5364
Practice Address - Street 1:817 LONGWOOD PL
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-9062
Practice Address - Country:US
Practice Address - Phone:214-802-1041
Practice Address - Fax:601-299-5364
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4110207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032321402Medicaid
TX032321402Medicaid
84082FMedicare ID - Type Unspecified