=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235592429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT THOMAS DEWAR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2016
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3417 GASTON AVE STE 1000
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75246-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-800-9000
-----------------------------------------------------
Fax | 469-800-9010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 226 W 14TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-913-0933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | T0076
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------