Healthcare Provider Details

I. General information

NPI: 1760549208
Provider Name (Legal Business Name): ROBERT C ROSTOMILY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST SUITE 900
HOUSTON TX
77030-2761
US

IV. Provider business mailing address

6560 FANNIN ST SUITE 900
HOUSTON TX
77030-2761
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-3800
  • Fax: 713-793-1015
Mailing address:
  • Phone: 713-441-3800
  • Fax: 713-793-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD00026698
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberR0491
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: