Provider Demographics
NPI:1912938416
Name:PRANGLE, ROBERT EDWIN (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWIN
Last Name:PRANGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13310 BEAMER RD STE G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6045
Mailing Address - Country:US
Mailing Address - Phone:281-481-4111
Mailing Address - Fax:281-481-0111
Practice Address - Street 1:13310 BEAMER RD
Practice Address - Street 2:SUITE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6093
Practice Address - Country:US
Practice Address - Phone:281-481-4111
Practice Address - Fax:281-481-0111
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00M971OtherBCBS
P00687812Medicare PIN