Provider Demographics
NPI:1538101605
Name:ROBERT, MARSHALL B (MD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:B
Last Name:ROBERT
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 1:211 E 7TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3218
Mailing Address - Country:US
Mailing Address - Phone:888-478-8432
Mailing Address - Fax:
Practice Address - Street 1:322 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5617
Practice Address - Country:US
Practice Address - Phone:888-478-8432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5364207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL080156896OtherRAILROAD MEDICARE
TX296017101Medicaid
IL343059OtherHEALTHLINK
IL036101648Medicaid
IL9150613OtherUNICARE
IL08526614OtherBCBS OF ILLINOIS
IL060286OtherHEALTH ALLIANCE
TX296017103Medicaid
TX296017102Medicaid
IL08526614OtherBCBS OF ILLINOIS
IL573460Medicare ID - Type Unspecified
TX296017101Medicaid
TXTXB152309Medicare PIN
IL060286OtherHEALTH ALLIANCE