Provider Demographics
NPI:1912196312
Name:ROBERT B. GUZMAN
Entity Type:Organization
Organization Name:ROBERT B. GUZMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-258-9570
Mailing Address - Street 1:PO BOX 2710
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-8710
Mailing Address - Country:US
Mailing Address - Phone:972-258-9570
Mailing Address - Fax:972-258-9569
Practice Address - Street 1:2435 E SOUTHLAKE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6679
Practice Address - Country:US
Practice Address - Phone:817-310-0922
Practice Address - Fax:817-310-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH90862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00247KOtherBLUE CROSS BLUE SHIELD
TX080223301Medicaid
TXD39157Medicare UPIN
TX00247KMedicare PIN