Provider Demographics
NPI:1679571335
Name:BORNSTEIN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BORNSTEIN
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 1:1300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3348
Mailing Address - Country:US
Mailing Address - Phone:257-617-6855
Mailing Address - Fax:
Practice Address - Street 1:1300 MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3348
Practice Address - Country:US
Practice Address - Phone:281-341-9696
Practice Address - Fax:281-762-6370
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5681208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335236101Medicaid
MA20153OtherHARVARD/PILGRIM
MABOA04024OtherBC/BS
MA2024675Medicaid
BOA04024Medicare ID - Type Unspecified