Provider Demographics
NPI:1982648440
Name:WROTEN, BOBBY J (MD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:J
Last Name:WROTEN
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 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:800 5TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7305
Practice Address - Country:US
Practice Address - Phone:817-702-9100
Practice Address - Fax:817-882-9242
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7371207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036074502Medicaid
TXP01195373OtherRAILROAD MEDICARE
TX8DN327OtherBCBS
TXP01195373OtherRAILROAD MEDICARE
TX262377YL1ZMedicare PIN