Provider Demographics
NPI:1659551174
Name:HAMAN, ROBERT MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:HAMAN
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 1:1239 E IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-4354
Mailing Address - Country:US
Mailing Address - Phone:972-579-8011
Mailing Address - Fax:972-579-9454
Practice Address - Street 1:1239 E IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-4354
Practice Address - Country:US
Practice Address - Phone:972-579-8011
Practice Address - Fax:972-579-9454
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112175801Medicaid
TX112175802Medicaid
TX00DE23Medicare PIN
TX112175802Medicaid