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NPI Code Detail

MEDICARE: DR. ROBERT D BURGOS M.D.

MEDICARE: DR. ROBERT D BURGOS 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
1207RG0100XGastroenterology PhysicianH4879TX
2174400000XSpecialistH4879TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1H4879OTHERTXSTATE LICENSE

General Provider Information

NPI Number : 1952359135
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT D BURGOS M.D.
Provider Business Mailing Address
First Line : PO BOX 6278
Second Line :
City : FORT WORTH
State : TX
Zip : 76115-0278
Country : US
Telephone Number : 817-568-5459
Fax Number : 817-568-5474
Provider Business Practice Location Address
First Line : 2300 LONE STAR RD
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-8744
Country : US
Telephone Number : 682-341-7210
Fax Number : 682-341-7212
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 01/27/2025

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