Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | L4668 | TX |
N | 2080A0000X | Adolescent Medicine | TXBL4668 | TX |
NPI | 1295736254 |
---|---|
Provider Name | Robert Mitchell Readinger |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-4430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H74323 | (02) | TX |