Provider Demographics
NPI:1972766012
Name:ROBERT PRANGLE DOPA
Entity type:Organization
Organization Name:ROBERT PRANGLE DOPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRANGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-481-4111
Mailing Address - Street 1:13310 BEAMER RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6045
Mailing Address - Country:US
Mailing Address - Phone:281-481-4111
Mailing Address - Fax:281-481-0111
Practice Address - Street 1:13310 BEAMER RD
Practice Address - Street 2:SUITE G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6045
Practice Address - Country:US
Practice Address - Phone:281-481-4111
Practice Address - Fax:281-481-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD97636261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00M971OtherBLUE CROSS BLUE SHIELD
TX390365OtherWELLCARE
TX390365OtherWELLCARE
TX1912938416Medicare UPIN