Provider Demographics
NPI:1356349583
Name:MYLES, ROBERT T (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:MYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:729 W BEDFORD EULESS RD
Mailing Address - Street 2:STE 206
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3939
Mailing Address - Country:US
Mailing Address - Phone:817-288-0084
Mailing Address - Fax:817-445-1039
Practice Address - Street 1:729 W BEDFORD EULESS RD
Practice Address - Street 2:STE 206
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-3941
Practice Address - Country:US
Practice Address - Phone:817-288-0084
Practice Address - Fax:817-445-1039
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK1579207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1579OtherTX MEDICAL LICENSE
TX046370501Medicaid
TX5991492OtherAETNA
F77548Medicare UPIN
TX20-5515096OtherNCTSI TAX ID
TX8F1646Medicare PIN