Provider Demographics
NPI:1609353374
Name:ROBERT GROYSMAN MD PA
Entity Type:Organization
Organization Name:ROBERT GROYSMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-302-7463
Mailing Address - Street 1:1350 W WALNUT HILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3025
Mailing Address - Country:US
Mailing Address - Phone:214-560-2000
Mailing Address - Fax:972-560-2555
Practice Address - Street 1:1350 W WALNUT HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3025
Practice Address - Country:US
Practice Address - Phone:214-560-2000
Practice Address - Fax:972-560-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5735207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty