Healthcare Provider Details

I. General information

NPI: 1699876458
Provider Name (Legal Business Name): ROBERT CHARLES BONTREGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13172 HIGHWAY 287
HASLET TX
76052-2619
US

IV. Provider business mailing address

5413 CANONBURY RD
ROSEDALE MD
21237-4902
US

V. Phone/Fax

Practice location:
  • Phone: 817-639-2830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN72225
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number239527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: