Provider Demographics
NPI:1588662456
Name:ENGELHART, ROBERT E (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:ENGELHART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 INTERNATIONAL PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4823
Mailing Address - Country:US
Mailing Address - Phone:817-334-0530
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:181 W MEADOW DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657
Practice Address - Country:US
Practice Address - Phone:970-476-2451
Practice Address - Fax:817-877-0350
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007108207L00000X
CODR.0050828207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114129880OtherMICHIGAN MEDICAID
OH050072650OtherRAILROAD MEDICARE
OH2161806Medicaid
OH2161806OtherBCMH
OH050065045OtherRAILROAD MEDICARE
OH0880351Medicare ID - Type UnspecifiedOHIO MEDICARE