Provider Demographics
NPI:1023067485
Name:SNOW, ROBERT G (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:SNOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2501 PARKVIEW DR STE 560
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5825
Mailing Address - Country:US
Mailing Address - Phone:817-850-1100
Mailing Address - Fax:817-850-1104
Practice Address - Street 1:2501 PARKVIEW DR STE 560
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5825
Practice Address - Country:US
Practice Address - Phone:817-850-1100
Practice Address - Fax:817-850-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8420208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N15HOtherBCBS
F33332Medicare UPIN