Provider Demographics
NPI:1104876879
Name:LOBSTEIN, HENRY P (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:P
Last Name:LOBSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:PHILEN
Other - Last Name:LOBSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1017 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3915
Mailing Address - Country:US
Mailing Address - Phone:817-334-2800
Mailing Address - Fax:817-336-1954
Practice Address - Street 1:1017 12TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3915
Practice Address - Country:US
Practice Address - Phone:817-334-2800
Practice Address - Fax:817-336-1954
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD3317207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4110720OtherAETNA PROVIDER ID
TX86463KOtherBCBS
TX1386534-10Medicaid
TX10013094OtherAMERIGROUP
TX1386534-02Medicaid
TX10013094OtherAMERIGROUP
TX1386534-02Medicaid
4110720OtherAETNA PROVIDER ID
TX060051188Medicare PIN
TX86463KMedicare PIN