Healthcare Provider Details

I. General information

NPI: 1093798944
Provider Name (Legal Business Name): ROBERT M MINGEA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S CHURCH ST SUITE A
LOCKHART TX
78644-2713
US

IV. Provider business mailing address

1400 N IH 35 SUITE 300
AUSTIN TX
78701-1926
US

V. Phone/Fax

Practice location:
  • Phone: 512-376-2183
  • Fax: 512-324-3449
Mailing address:
  • Phone: 512-324-8300
  • Fax: 512-324-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH1154
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberH1154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: