Provider Demographics
NPI:1740783968
Name:ROBERTS, GEORGE
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W AURORA VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:TX
Mailing Address - Zip Code:76078-4650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 W AURORA VISTA TRL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:TX
Practice Address - Zip Code:76078-4650
Practice Address - Country:US
Practice Address - Phone:817-504-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant