Provider Demographics
NPI:1386855922
Name:GOTTLIEB, ROBERT LAWRENCE (MD PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:GOTTLIEB
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:3410 WORTH ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2003
Mailing Address - Country:US
Mailing Address - Phone:214-820-6856
Mailing Address - Fax:214-820-1474
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-820-6856
Practice Address - Fax:214-820-1474
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2013-01783207R00000X, 207RC0000X
TXQ6197207R00000X, 207RC0000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3539785-01Medicaid
TX3539785-02Medicaid
TX466176YKTPMedicare PIN
TX466176YKY6Medicare PIN