Provider Demographics
NPI:1124077573
Name:IPPOLITO, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:IPPOLITO
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 1:9221 LBJ FWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3455
Mailing Address - Country:US
Mailing Address - Phone:972-644-8577
Mailing Address - Fax:972-644-8577
Practice Address - Street 1:9 MEDICAL PKWY STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7852
Practice Address - Country:US
Practice Address - Phone:214-553-3323
Practice Address - Fax:214-553-3308
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH96532082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096867902Medicaid
TXMDH9653OtherWORKERS COMPENSATIONS
TX0063EQOtherBC/BS
TX096867903Medicaid
TX00726LMedicare PIN
TX240007030Medicare PIN
TXE66728Medicare UPIN
TX096867903Medicaid