Provider Demographics
NPI:1134395015
Name:ROBERT T. WARHOLA, D.O., P.A
Entity type:Organization
Organization Name:ROBERT T. WARHOLA, D.O., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WARHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:409-736-2800
Mailing Address - Street 1:5885 W PORT ARTHUR RD
Mailing Address - Street 2:P. O. BOX 5549
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-1754
Mailing Address - Country:US
Mailing Address - Phone:409-736-2800
Mailing Address - Fax:409-736-0361
Practice Address - Street 1:5885 W PORT ARTHUR RD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-1754
Practice Address - Country:US
Practice Address - Phone:409-736-2800
Practice Address - Fax:409-736-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1105819-01Medicaid
00J017OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX4584936OtherAETNA
TX1105819-01Medicaid