Healthcare Provider Details

I. General information

NPI: 1477282721
Provider Name (Legal Business Name): ROBERT DALE ORR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 W MAIN ST
GUN BARREL CITY TX
75156-3638
US

IV. Provider business mailing address

12225 COUNTY ROAD 4088
SCURRY TX
75158-2939
US

V. Phone/Fax

Practice location:
  • Phone: 903-713-2000
  • Fax:
Mailing address:
  • Phone: 214-538-5683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number923897
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1086303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: