Provider Demographics
NPI:1700826260
Name:ROBERTS, ANDREW C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4002 S LOOP 256 STE G
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8499
Mailing Address - Country:US
Mailing Address - Phone:903-731-5305
Mailing Address - Fax:903-731-5309
Practice Address - Street 1:1615 HOSPITAL PKWY STE 204
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5936
Practice Address - Country:US
Practice Address - Phone:817-784-8268
Practice Address - Fax:817-283-8003
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9888208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042921902Medicaid
TX8287B7Medicare PIN
TXH14303Medicare UPIN