Provider Demographics
NPI:1255388013
Name:ROBERT R IPPOLITO, MD, PA
Entity type:Organization
Organization Name:ROBERT R IPPOLITO, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:IPPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-867-2731
Mailing Address - Street 1:9221 LBJ FWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3455
Mailing Address - Country:US
Mailing Address - Phone:972-644-8577
Mailing Address - Fax:972-644-8577
Practice Address - Street 1:9 MEDICAL PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7858
Practice Address - Country:US
Practice Address - Phone:972-919-4747
Practice Address - Fax:972-919-4749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182655401Medicaid
TX182655401Medicaid
TX00W888Medicare PIN