Provider Demographics
NPI:1669467445
Name:BROCKIE, ROBERT EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWIN
Last Name:BROCKIE
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 1:490 US HIGHWAY 80 E STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9212
Mailing Address - Country:US
Mailing Address - Phone:972-279-3500
Mailing Address - Fax:972-279-3505
Practice Address - Street 1:490 US HIGHWAY 80 E STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9212
Practice Address - Country:US
Practice Address - Phone:972-279-3500
Practice Address - Fax:972-279-3505
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3182207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060030959OtherMEDICARE RAILROAD
TX129350801Medicaid
TX129350804Medicaid
TX85C466OtherBCBS
TX129350803Medicaid
TX81G603OtherBCBS
TX060031535OtherMEDICARE RAILROAD
TX060030959OtherMEDICARE RAILROAD
TX129350803Medicaid
TX85C466OtherBCBS
TX84J08ZMedicare ID - Type Unspecified