Provider Demographics
NPI:1902858566
Name:PAUL, ROBERT ALAN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:PAUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SPROLES DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3249
Mailing Address - Country:US
Mailing Address - Phone:817-249-4100
Mailing Address - Fax:817-249-4185
Practice Address - Street 1:114 SPROLES DR STE 101
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-3249
Practice Address - Country:US
Practice Address - Phone:817-249-4100
Practice Address - Fax:817-249-4185
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039797802Medicaid
TX039797803Medicaid
TX8A7621Medicare PIN
TX8C9816Medicare ID - Type Unspecified
TXG37986Medicare UPIN