Provider Demographics
NPI:1467440073
Name:CLOUD, ROBERT ROYCE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROYCE
Last Name:CLOUD
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 1:124 MALLARD XING
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-2042
Mailing Address - Country:US
Mailing Address - Phone:903-869-9844
Mailing Address - Fax:297-830-4256
Practice Address - Street 1:124 MALLARD XING
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-2042
Practice Address - Country:US
Practice Address - Phone:903-869-9844
Practice Address - Fax:207-830-4256
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0977174400000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115239905Medicaid
TX115239906Medicaid
TX115239907Medicaid
TX115239905Medicaid
TXTXB112165Medicare PIN
TXTXB112161Medicare PIN
TXTXB112163Medicare PIN