MEDICARE: DR. ROBERT T MYLES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	K1579	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K1579	OTHER	TX	TX MEDICAL LICENSE

General Provider Information

NPI Number	:	1356349583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT T MYLES MD

Provider Business Mailing Address
First Line	:	729 W BEDFORD EULESS RD
Second Line	:	STE 206
City	:	HURST
State	:	TX
Zip	:	76053-3939
Country	:	US
Telephone Number	:	817-288-0084
Fax Number	:	817-445-1039

Provider Business Practice Location Address
First Line	:	729 W BEDFORD EULESS RD
Second Line	:	STE 206
City	:	HURST
State	:	TX
Zip	:	76053-3941
Country	:	US
Telephone Number	:	817-288-0084
Fax Number	:	817-445-1039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/16/2018

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