Provider Demographics
NPI:1194773085
Name:ROSENTHAL, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:ROSENTHAL
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 1:621 N HALL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1339
Mailing Address - Country:US
Mailing Address - Phone:469-800-7425
Mailing Address - Fax:469-800-7440
Practice Address - Street 1:621 N HALL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1339
Practice Address - Country:US
Practice Address - Phone:469-800-7425
Practice Address - Fax:469-800-7440
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137586705Medicaid
TX137586711Medicaid
TX137586712Medicaid
TX137586702Medicaid
TX137586711Medicaid
TX85G121Medicare PIN
TX83Z634Medicare PIN
TX359359YKTPMedicare PIN
TX137586702Medicaid