Provider Demographics
NPI:1720017205
Name:ANGELIER, ROBERT THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:ANGELIER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3565
Mailing Address - Country:US
Mailing Address - Phone:214-217-3668
Mailing Address - Fax:214-217-3669
Practice Address - Street 1:6330 BROADWAY BLVD
Practice Address - Street 2:D-2
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-5991
Practice Address - Country:US
Practice Address - Phone:972-226-0774
Practice Address - Fax:972-226-9727
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0590213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89261NMedicare ID - Type Unspecified
TXT11961Medicare UPIN