Provider Demographics
NPI:1578889887
Name:ROBIN A ROBERTS, MD
Entity Type:Organization
Organization Name:ROBIN A ROBERTS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-989-1221
Mailing Address - Street 1:6100 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3930
Mailing Address - Country:US
Mailing Address - Phone:817-989-1221
Mailing Address - Fax:817-989-1175
Practice Address - Street 1:6100 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3930
Practice Address - Country:US
Practice Address - Phone:817-989-1221
Practice Address - Fax:817-989-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3210174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty