Healthcare Provider Details

I. General information

NPI: 1225235179
Provider Name (Legal Business Name): ROBERT DAVID MENZIES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7148 TRAIL LAKE DR
FORT WORTH TX
76123-1969
US

IV. Provider business mailing address

7148 TRAIL LAKE DR
FORT WORTH TX
76123-1969
US

V. Phone/Fax

Practice location:
  • Phone: 817-294-0934
  • Fax: 817-294-1488
Mailing address:
  • Phone: 817-294-0934
  • Fax: 817-294-1488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberM3643
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM3643
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: