Basic Information
| Provider Information | |||||||||
| NPI: | 1124077573 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IPPOLITO | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9221 LBJ FWY | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752433455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726448577 | ||||||||
| FaxNumber: | 9726448577 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 MEDICAL PKWY STE 102 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752347852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2145533323 | ||||||||
| FaxNumber: | 2145533308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2082S0105X | H9653 | TX | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 096867902 | 05 | TX | MEDICAID | MDH9653 | 01 | TX | WORKERS COMPENSATIONS | OTHER | 0063EQ | 01 | TX | BC/BS | OTHER | 096867903 | 05 | TX | MEDICAID |