Provider Demographics
NPI:1174566525
Name:ROBINSON, RICHARD DANE (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 HARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4082
Mailing Address - Country:US
Mailing Address - Phone:979-571-1660
Mailing Address - Fax:
Practice Address - Street 1:3808 HARLEY AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4082
Practice Address - Country:US
Practice Address - Phone:979-571-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6552207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176951501Medicaid
TX176951505Medicaid
TX8BR220OtherBCBS
TX8BR220OtherBCBS
TXP00323439Medicare PIN
TX8G0829Medicare PIN
TX8L2498Medicare PIN
TXP00725716Medicare PIN