MEDICARE: DR. ROBERT ROSS HOUSTON M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35045380	OH
2	207RC0000X	Cardiovascular Disease Physician	MD017919E	PA
3	207UN0901X	Nuclear Cardiology Physician	35045380	OH
4	207UN0901X	Nuclear Cardiology Physician	MD017919E	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1932105210	OTHER	OH	NPI
4	1932105210	OTHER	PA	NPI

NPI Number	:	1932105210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ROSS HOUSTON M.D.

Provider Business Mailing Address
First Line	:	715 E WESTERN RESERVE RD
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-3358
Country	:	US
Telephone Number	:	330-726-3204
Fax Number	:	330-729-9316

Provider Business Practice Location Address
First Line	:	715 E WESTERN RESERVE RD
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-3358
Country	:	US
Telephone Number	:	330-726-3204
Fax Number	:	330-729-9316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/19/2016

715 E WESTERN RESERVE RD FL 2
POLAND, OH
44514-3358

Practice Phone: 339-965-3363
Practice Fax: 330-729-7701