Healthcare Provider Details

I. General information

NPI: 1114922507
Provider Name (Legal Business Name): ROBERT M TAFEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 WESTPARK WAY
EULESS TX
76040-3957
US

IV. Provider business mailing address

469 WESTPARK WAY
EULESS TX
76040-3957
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-2888
  • Fax: 817-283-1181
Mailing address:
  • Phone: 817-283-2888
  • Fax: 817-283-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD8831
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: