Provider Demographics
NPI:1962483107
Name:STERN, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:STERN
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:PO BOX 164106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-4106
Mailing Address - Country:US
Mailing Address - Phone:512-901-1206
Mailing Address - Fax:512-901-1299
Practice Address - Street 1:2000 SCENIC DR
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7726
Practice Address - Country:US
Practice Address - Phone:512-943-3000
Practice Address - Fax:512-942-4781
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0166207ZP0102X
NC027095207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123771104Medicaid
TX123771108Medicaid
TX123771106Medicaid
TX123771105OtherCSHCN
TX8Z0892OtherBCBS
TX8Z0892OtherBCBS
TX123771108Medicaid
TX8J2133Medicare PIN
TX220031827Medicare PIN
TX8L5688Medicare PIN