Provider Demographics
NPI:1194875518
Name:ROBERT W. KOSHMAN, MD, PA
Entity type:Organization
Organization Name:ROBERT W. KOSHMAN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-932-6565
Mailing Address - Street 1:915 GESSNER RD # 569
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2527
Mailing Address - Country:US
Mailing Address - Phone:713-932-6565
Mailing Address - Fax:713-932-6507
Practice Address - Street 1:915 GESSNER RD STE 560
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2549
Practice Address - Country:US
Practice Address - Phone:713-932-6565
Practice Address - Fax:713-932-6507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J80JMedicare ID - Type Unspecified
TXB24090Medicare UPIN