Healthcare Provider Details

I. General information

NPI: 1083047625
Provider Name (Legal Business Name): ROBERT F. DEMURO JR. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2013
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W MEDICAL CT
WICHITA FALLS TX
76310-1767
US

IV. Provider business mailing address

1 W MEDICAL CT
WICHITA FALLS TX
76310-1767
US

V. Phone/Fax

Practice location:
  • Phone: 940-247-4553
  • Fax: 940-689-9662
Mailing address:
  • Phone: 940-247-4553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA08709
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: