Healthcare Provider Details

I. General information

NPI: 1023835576
Provider Name (Legal Business Name): ROBERT CLOUD MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E RALPH HALL PKWY # 160
ROCKWALL TX
75032-6878
US

IV. Provider business mailing address

3021 RIDGE RD # 141
ROCKWALL TX
75032-5830
US

V. Phone/Fax

Practice location:
  • Phone: 972-497-2111
  • Fax: 207-830-4256
Mailing address:
  • Phone: 972-497-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT CLOUD
Title or Position: OWNER
Credential: MD
Phone: 972-497-2111