Provider Demographics
NPI:1104004357
Name:LYNNE J. ROBERTS, M.D., P. A.
Entity Type:Organization
Organization Name:LYNNE J. ROBERTS, M.D., P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-232-9300
Mailing Address - Street 1:7502 GREENVILLE AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3832
Mailing Address - Country:US
Mailing Address - Phone:469-232-9300
Mailing Address - Fax:469-232-9850
Practice Address - Street 1:7502 GREENVILLE AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3832
Practice Address - Country:US
Practice Address - Phone:469-232-9300
Practice Address - Fax:469-232-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8647207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4111259OtherAETNA
415509OtherPHCS
00F78BOtherBCBS
C21126OtherUPIN
415509OtherPHCS