Provider Demographics
NPI:1962491431
Name:MIDDENDORF, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MIDDENDORF
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 1:5494 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4308
Mailing Address - Country:US
Mailing Address - Phone:214-692-6220
Mailing Address - Fax:214-696-1579
Practice Address - Street 1:5494 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4308
Practice Address - Country:US
Practice Address - Phone:214-692-6220
Practice Address - Fax:214-696-1579
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8035207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099305701Medicaid
TX099305705Medicaid
TX180027120OtherRAILROAD MEDICARE
TXB24893Medicare UPIN
TX8E0492Medicare PIN
TX099305701Medicaid