Healthcare Provider Details

I. General information

NPI: 1275025371
Provider Name (Legal Business Name): ROBERT HARBOLOVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 E GENERAL CAVAZOS BLVD
KINGSVILLE TX
78363-7150
US

IV. Provider business mailing address

402 CAPE HATTERAS DR
CORPUS CHRISTI TX
78412-2666
US

V. Phone/Fax

Practice location:
  • Phone: 361-595-1661
  • Fax:
Mailing address:
  • Phone: 361-236-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT1715
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84769
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberT1715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: