Healthcare Provider Details

I. General information

NPI: 1194773085
Provider Name (Legal Business Name): ROBERT L ROSENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 N HALL ST SUITE 400
DALLAS TX
75226-1339
US

IV. Provider business mailing address

621 N HALL ST SUITE 400
DALLAS TX
75226-1339
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-7425
  • Fax: 469-800-7440
Mailing address:
  • Phone: 469-800-7425
  • Fax: 469-800-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG0031
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: