Basic Information
| Provider Information | |||||||||
| NPI: | 1639494032 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISFORT | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 633448 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452633448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135696117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10600 MONTGOMERY RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452424463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137945600 | ||||||||
| FaxNumber: | 5132811908 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2010 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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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 | 207RG0100X | 35.128132 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 01076577A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.