Provider Demographics
NPI:1952402638
Name:ROBITAILLE, DORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:ROBITAILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 RANCH ROAD 620 S
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6317
Mailing Address - Country:US
Mailing Address - Phone:512-263-0300
Mailing Address - Fax:512-263-4045
Practice Address - Street 1:1411 RANCH ROAD 620 S
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6317
Practice Address - Country:US
Practice Address - Phone:512-263-0300
Practice Address - Fax:512-263-4045
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6554207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE95921Medicare UPIN