MEDICARE: DR. ROBERT JOSEPH MEDELL M.D.

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	207L00000X	Anesthesiology Physician	J5834	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467433631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOSEPH MEDELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 840853
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0853
Country	:	US
Telephone Number	:	210-477-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 VANCE JACKSON RD
Second Line	:	SUITE 220
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-5336
Country	:	US
Telephone Number	:	210-477-2409
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/02/2021

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