Provider Demographics
NPI:1497902852
Name:ROBERTS, JOHN JASON (RT(R))
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JASON
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:67 WILDFLOWER TRACE PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1540
Mailing Address - Country:US
Mailing Address - Phone:281-620-1457
Mailing Address - Fax:281-419-3477
Practice Address - Street 1:67 WILDFLOWER TRACE PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1540
Practice Address - Country:US
Practice Address - Phone:281-620-1457
Practice Address - Fax:281-419-3477
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX913852471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography