Provider Demographics
NPI:1154392082
Name:NETTUNE, ROBERT JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:NETTUNE
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 1:5773 IMPALA SOUTH ROAD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75752-6053
Mailing Address - Country:US
Mailing Address - Phone:903-681-4840
Mailing Address - Fax:
Practice Address - Street 1:5773 IMPALA SOUTH ROAD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75752-6053
Practice Address - Country:US
Practice Address - Phone:903-681-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8591207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
88E866OtherBLUE CROSS BLUE SHIELD
TX082217301Medicaid
2217840OtherCIGNA
0456290OtherUNITED HEALTH CARE
4412054OtherAETNA
B25136Medicare UPIN