Basic Information
| Provider Information | |||||||||
| NPI: | 1912196312 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROBERT B. GUZMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2710 | ||||||||
| Address2: | |||||||||
| City: | COPPELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750198710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722589570 | ||||||||
| FaxNumber: | 9722589569 | ||||||||
| Practice Location | |||||||||
| Address1: | 2435 E SOUTHLAKE BLVD STE 140 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760926679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173100922 | ||||||||
| FaxNumber: | 8173100910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2007 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | BILLMAN | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLAIMS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9722589570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | H9086 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 00247K | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 080223301 | 05 | TX | MEDICAID |