Provider Demographics
NPI:1932708351
Name:ROBERT D. KISTLER MD
Entity Type:Organization
Organization Name:ROBERT D. KISTLER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:KISTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-2231
Mailing Address - Street 1:3804 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5780
Mailing Address - Country:US
Mailing Address - Phone:936-634-2231
Mailing Address - Fax:936-634-8012
Practice Address - Street 1:3804 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5780
Practice Address - Country:US
Practice Address - Phone:936-634-2231
Practice Address - Fax:936-634-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG8217OtherLICENSE