Provider Demographics
NPI:1922407576
Name:ROBERT L. FORDTRAN, MD PA
Entity Type:Organization
Organization Name:ROBERT L. FORDTRAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:FORDTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-884-6115
Mailing Address - Street 1:1001 LOUISIANA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2833
Mailing Address - Country:US
Mailing Address - Phone:361-884-6115
Mailing Address - Fax:
Practice Address - Street 1:1001 LOUISIANA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2833
Practice Address - Country:US
Practice Address - Phone:361-884-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5669207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty