MEDICARE: DR. ROBERT DANIEL PHELPS DPM

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	213E00000X	Podiatrist	1636	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00040744	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1636	OTHER	TX	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881689560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DANIEL PHELPS DPM

Provider Business Mailing Address
First Line	:	1828 E SOUTHEAST LOOP 323 STE 111
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-8314
Country	:	US
Telephone Number	:	903-593-0987
Fax Number	:	903-592-3309

Provider Business Practice Location Address
First Line	:	1828 E SOUTHEAST LOOP 323 STE 111
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-8314
Country	:	US
Telephone Number	:	903-593-0987
Fax Number	:	903-592-3309

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	05/13/2024

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