Provider Demographics
NPI:1841576394
Name:RUSSELL R ROBY MD
Entity Type:Organization
Organization Name:RUSSELL R ROBY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRED
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-338-4336
Mailing Address - Street 1:5000 BEE CAVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5266
Mailing Address - Country:US
Mailing Address - Phone:512-338-4336
Mailing Address - Fax:
Practice Address - Street 1:5000 BEE CAVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5266
Practice Address - Country:US
Practice Address - Phone:512-338-4336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1255207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty