Provider Demographics
NPI:1932243250
Name:KONCHAR, ROBERT G (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:KONCHAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 KENT ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5805
Mailing Address - Country:US
Mailing Address - Phone:432-683-3521
Mailing Address - Fax:432-687-0040
Practice Address - Street 1:604 KENT ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5805
Practice Address - Country:US
Practice Address - Phone:432-683-3521
Practice Address - Fax:432-687-0040
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX845213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T14249Medicare UPIN
TXBY24Medicare ID - Type Unspecified