Healthcare Provider Details

I. General information

NPI: 1396989042
Provider Name (Legal Business Name): DYLAN BLUE MEDLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2009
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 IH-69E N SUITE 325
ROBSTOWN TX
78380
US

IV. Provider business mailing address

500 IH-69E N SUITE 325
ROBSTOWN TX
78380
US

V. Phone/Fax

Practice location:
  • Phone: 361-222-5668
  • Fax:
Mailing address:
  • Phone: 361-222-5668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN7462
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: