Provider Demographics
NPI:1952504276
Name:KROMBACH, ROBERT STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:KROMBACH
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 1:2800 E BROAD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6410
Mailing Address - Country:US
Mailing Address - Phone:682-518-1035
Mailing Address - Fax:682-518-1045
Practice Address - Street 1:2800 E BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6410
Practice Address - Country:US
Practice Address - Phone:682-518-1035
Practice Address - Fax:682-518-1045
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1850207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190091202Medicaid
TX190091201Medicaid
TX190091202Medicaid
TXOTH001Medicare UPIN
TX8J8457Medicare PIN