Healthcare Provider Details

I. General information

NPI: 1679571335
Provider Name (Legal Business Name): ROBERT BORNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAIN ST
RICHMOND TX
77469-3348
US

IV. Provider business mailing address

1300 MAIN ST
RICHMOND TX
77469-3348
US

V. Phone/Fax

Practice location:
  • Phone: 281-341-9696
  • Fax: 281-762-6370
Mailing address:
  • Phone: 257-617-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5681
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: