Provider Demographics
NPI:1518986918
Name:KOSHMAN, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:KOSHMAN
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 1:819 W FOREST DR
Mailing Address - Street 2:SUITE 560
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3331
Mailing Address - Country:US
Mailing Address - Phone:713-819-2292
Mailing Address - Fax:
Practice Address - Street 1:915 GESSNER RD
Practice Address - Street 2:SUITE 560
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2572
Practice Address - Country:US
Practice Address - Phone:713-932-6565
Practice Address - Fax:713-932-6507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1693174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0886050001Medicare NSC
TXB24090Medicare UPIN
TX00J80JMedicare ID - Type UnspecifiedMEDICARE#