Healthcare Provider Details

I. General information

NPI: 1427039445
Provider Name (Legal Business Name): ROBERT G KADOKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 L DON DODSON DR STE 110
BEDFORD TX
76021-1844
US

IV. Provider business mailing address

2008 L DON DODSON DR STE 110
BEDFORD TX
76021-1844
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-0967
  • Fax: 817-358-4566
Mailing address:
  • Phone: 817-283-0967
  • Fax: 817-358-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM1808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: