Provider Demographics
NPI:1922177500
Name:ESWEIN, ROBERT LARRY (LSA, CSA, OPA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LARRY
Last Name:ESWEIN
Suffix:
Gender:M
Credentials:LSA, CSA, OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76068-1481
Mailing Address - Country:US
Mailing Address - Phone:940-452-1708
Mailing Address - Fax:940-325-0199
Practice Address - Street 1:403 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-4201
Practice Address - Country:US
Practice Address - Phone:940-452-1708
Practice Address - Fax:940-325-0199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TXCERTIFICATE # 852363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNSAA 3369OtherNATIONAL SURGICAL ASSISTANTS ASSOCIATION
TX852OtherNATIONAL BOARD OF CERTIFICATION ORTHOPAEDIC PHYSICIAN ASSISTANTS (NBCOPA)
TXSA00340OtherTEXAS MEDICAL BOAD