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MR. ROBERT RYAN DISOTELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ANP

Contact information

Practice address
2604 SAINT MICHAEL DR STE 340, TEXARKANA, TX 75503-2378
(903) 614-5117
Mailing address
202 QUAIL LN, WAKE VILLAGE, TX 75501-5722
(870) 292-9960

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
A03684
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1994
TX LICENSE
TX
01
A03684
LICENSE
AR
Enumeration date
04/09/2012
Last updated
04/27/2018
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