Healthcare Provider Details

I. General information

NPI: 1093895724
Provider Name (Legal Business Name): ROBERT WIMBERLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 WELBORN STREET
DALLAS TX
75219-3924
US

IV. Provider business mailing address

2222 WELBORN ST
DALLAS TX
75219-3924
US

V. Phone/Fax

Practice location:
  • Phone: 214-559-5000
  • Fax: 214-443-7309
Mailing address:
  • Phone: 214-559-5000
  • Fax: 214-443-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberL7605
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberL7605
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: