Provider Demographics
NPI:1194764043
Name:KOBYLAR, RICHARD (DPM)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:KOBYLAR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOSPITAL CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414-4772
Mailing Address - Country:US
Mailing Address - Phone:979-245-9500
Mailing Address - Fax:979-323-7370
Practice Address - Street 1:600 HOSPITAL CIR STE 103
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4772
Practice Address - Country:US
Practice Address - Phone:979-245-9500
Practice Address - Fax:979-323-7370
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1691213ES0103X, 332B00000X, 332BC3200X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1052331OtherBCBS BLUELINK
TX181694401Medicaid
TX7311810OtherAETNA
TX610980Medicare PIN
TXV01592Medicare UPIN
TX181694401Medicaid