Provider Demographics
NPI:1174603369
Name:MONZINGO, ROBERT LEONARD JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEONARD
Last Name:MONZINGO
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2621
Mailing Address - Country:US
Mailing Address - Phone:214-288-2329
Mailing Address - Fax:
Practice Address - Street 1:2810 HARDIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7490
Practice Address - Country:US
Practice Address - Phone:972-548-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00502363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283638902Medicaid
TX283638901Medicaid
TXTXB125258Medicare PIN
TXTXB125231Medicare PIN
TX283638902Medicaid