Provider Demographics
NPI:1598783656
Name:CASE, ROBERTA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:M
Last Name:CASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5946
Mailing Address - Country:US
Mailing Address - Phone:432-687-1981
Mailing Address - Fax:432-687-0721
Practice Address - Street 1:2010 W OHIO AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5946
Practice Address - Country:US
Practice Address - Phone:432-687-1981
Practice Address - Fax:432-687-0721
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3425207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HJ47OtherBCBS
TX120242601Medicaid
TXC14265Medicare UPIN
TX00HJ47Medicare PIN