Healthcare Provider Details

I. General information

NPI: 1518986918
Provider Name (Legal Business Name): ROBERT W KOSHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 GESSNER RD SUITE 560
HOUSTON TX
77024-2572
US

IV. Provider business mailing address

819 W FOREST DR SUITE 560
HOUSTON TX
77079-3331
US

V. Phone/Fax

Practice location:
  • Phone: 713-932-6565
  • Fax: 713-932-6507
Mailing address:
  • Phone: 713-819-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG1693
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: