Provider Demographics
NPI:1295736254
Name:READINGER, ROBERT MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MITCHELL
Last Name:READINGER
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1108 S HENDERSON ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4430
Practice Address - Country:US
Practice Address - Phone:817-335-3255
Practice Address - Fax:817-338-9563
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXBL46682080A0000X
TXL4668208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FE417OtherBCBX-TX
TX188758002Medicaid
TX416399YMJCMedicare PIN
TX8FE417OtherBCBX-TX