Provider Demographics
NPI:1619498490
Name:ROBERTS, JOHN HERMAN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HERMAN
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5016 S US 75
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 GALLAHER DR.
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090
Practice Address - Country:US
Practice Address - Phone:903-416-4000
Practice Address - Fax:903-771-2849
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8261208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR8261OtherTEXAS LICENSE
TXFR7735674OtherDEA