Provider Demographics
NPI:1871591719
Name:MAHAFFEY, ROBERT KARL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KARL
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 LAKE RD
Mailing Address - Street 2:A
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77340-5756
Mailing Address - Country:US
Mailing Address - Phone:936-436-9098
Mailing Address - Fax:936-439-9098
Practice Address - Street 1:2507 LAKE RD
Practice Address - Street 2:A
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5756
Practice Address - Country:US
Practice Address - Phone:936-436-9098
Practice Address - Fax:936-439-9098
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128760902Medicaid
TX612713Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX080131169Medicare ID - Type UnspecifiedRR MEDICARE
TX128760902Medicaid
TXC18681Medicare UPIN