Provider Demographics
NPI:1932587730
Name:BOCCACCIO, ROBERT BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:BOCCACCIO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:505 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2099
Mailing Address - Country:US
Mailing Address - Phone:817-468-3255
Mailing Address - Fax:817-468-7823
Practice Address - Street 1:505 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2099
Practice Address - Country:US
Practice Address - Phone:817-468-3255
Practice Address - Fax:817-468-7823
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1053207V00000X
OK5946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology