Provider Demographics
NPI:1760549208
Name:ROSTOMILY, ROBERT C
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:ROSTOMILY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-3800
Mailing Address - Fax:713-793-1015
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-3800
Practice Address - Fax:713-793-1015
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026698207T00000X
TXR0491207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GJ312OtherBCBS
WA1760549208Medicaid
7542OtherINTERNAL ID-MOTOR VEHICLE ID
WA0231760OtherL&I
F77092Medicare UPIN
WA0231760OtherL&I
TX8GJ312OtherBCBS