Provider Demographics
NPI:1689645194
Name:CLINE, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:CLINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4106 MEDICAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3722
Mailing Address - Country:US
Mailing Address - Phone:512-418-1763
Mailing Address - Fax:512-372-9388
Practice Address - Street 1:4106 MEDICAL PARKWAY STREET
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3722
Practice Address - Country:US
Practice Address - Phone:512-418-1763
Practice Address - Fax:512-372-9388
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7283208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100134903Medicaid
TX8BG300OtherBLUE CROSS OF TEXAS
TX8F7397Medicare PIN
TX8BG300OtherBLUE CROSS OF TEXAS
TXF78043Medicare UPIN
TX00G96PMedicare PIN