Provider Demographics
NPI:1710252705
Name:ROBERTS, EDWARD ROY (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ROY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20518 LAVERTON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2013
Mailing Address - Country:US
Mailing Address - Phone:281-578-7787
Mailing Address - Fax:281-578-7787
Practice Address - Street 1:20518 LAVERTON DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2013
Practice Address - Country:US
Practice Address - Phone:281-578-7787
Practice Address - Fax:281-578-7787
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1029172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty