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General NPI Number Information
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NPI Number | 1831340769
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Entity Type | Individual
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Provider Name | ROBERT ELLIS SOUTHARD MD
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Gender | Male
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 1504 TAUB LOOP
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City | HOUSTON
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State | TX
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Zip | 77030-1608
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Country | US
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Telephone | 713-873-8890
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BAYLOR PLZ MS: BCM 390
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City | HOUSTON
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State | TX
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Zip | 77030-3411
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Country | US
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Telephone | 713-798-8051
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Fax | 713-798-2744
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | Q5725
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | Q5725
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License Number State | TX
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