Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | M3643 | TX |
NPI | 1225235179 |
---|---|
Provider Name | Dr. Robert David Menzies |
First Address | Fort Worth, TX 76123-1969 |
Second Address | Fort Worth, TX 76123-1969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 17/03/2018 |