Provider Demographics
NPI:1356460265
Name:GARY F ROBERTS MD
Entity Type:Organization
Organization Name:GARY F ROBERTS MD
Other - Org Name:OATES FAMILY PRACTICE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-223-8221
Mailing Address - Street 1:PO BOX 940801
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-0801
Mailing Address - Country:US
Mailing Address - Phone:972-223-8221
Mailing Address - Fax:972-223-0733
Practice Address - Street 1:2692 N GALLOWAY AVE STE 401
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6361
Practice Address - Country:US
Practice Address - Phone:972-223-8221
Practice Address - Fax:972-223-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080033133OtherMEDICARE RAILROAD
TX033735401Medicaid
TX00H48VMedicare PIN
TXB65537Medicare UPIN