Provider Demographics
NPI:1629084983
Name:MEYERSON, ROBERT Y (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:Y
Last Name:MEYERSON
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 1:4101 BRADWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1132
Mailing Address - Country:US
Mailing Address - Phone:512-217-7187
Mailing Address - Fax:
Practice Address - Street 1:14427 CHASE ST STE 100
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3020
Practice Address - Country:US
Practice Address - Phone:818-830-7751
Practice Address - Fax:818-891-7892
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123752105Medicaid
TX123752110Medicaid
TX123752102Medicaid
TX123752111Medicaid
TX8K0666Medicare PIN
TX86C686Medicare PIN
TX080104080Medicare PIN
TX123752102Medicaid
TX321844YKXYMedicare PIN