Provider Demographics
NPI:1457367443
Name:BIDWELL, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BIDWELL
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 1:3113 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79103-2700
Mailing Address - Country:US
Mailing Address - Phone:806-374-7341
Mailing Address - Fax:806-322-0533
Practice Address - Street 1:3113 ROSS ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103-2700
Practice Address - Country:US
Practice Address - Phone:806-374-7341
Practice Address - Fax:806-322-0533
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138819117Medicaid
TX8V3537OtherBCBS TX
TXP00642527OtherMEDICARE RAILROAD
TXP00642527OtherMEDICARE RAILROAD
TX8V3537OtherBCBS TX