Provider Demographics
NPI:1659319424
Name:ROBERT, REBECCA MARING (MD)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MARING
Last Name:ROBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 LANCASTER DRIVE
Mailing Address - Street 2:SUITE #220
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-2113
Mailing Address - Country:US
Mailing Address - Phone:817-865-5300
Mailing Address - Fax:817-442-9841
Practice Address - Street 1:1631 LANCASTER DRIVE
Practice Address - Street 2:SUITE #220
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-2113
Practice Address - Country:US
Practice Address - Phone:817-865-5300
Practice Address - Fax:817-442-9841
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2016-05-25
Deactivation Date:2007-06-20
Deactivation Code:
Reactivation Date:2008-08-28
Provider Licenses
StateLicense IDTaxonomies
TXK0548207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029692301Medicaid
TX029692301Medicaid
8F8480Medicare PIN