Provider Demographics
NPI:1851303135
Name:MIMS, ROBERT LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:MIMS
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 1:900 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2537
Mailing Address - Country:US
Mailing Address - Phone:817-429-7546
Mailing Address - Fax:817-886-3615
Practice Address - Street 1:900 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2537
Practice Address - Country:US
Practice Address - Phone:817-429-7546
Practice Address - Fax:817-886-3615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF98272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114886803Medicaid
TX114886803Medicaid
B24921Medicare UPIN