Provider Demographics
NPI:1750333258
Name:ROBERTS, SAM SWINFORD III (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:SWINFORD
Last Name:ROBERTS
Suffix:III
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 1:3106 RIVA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 W 38TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1006
Practice Address - Country:US
Practice Address - Phone:512-324-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1940207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139425614Medicaid
TX139425638Medicaid
TX139425640Medicaid
TX139425629Medicaid
TX139425624Medicaid
TX139425631Medicaid
TX139425625Medicaid
TX139425641Medicaid
TX139425639Medicaid
TX139425612Medicaid
TX139425626Medicaid
TX139425609Medicaid
TX139425627Medicaid
TX139425609Medicaid
TX8F5113Medicare PIN
TX139425612Medicaid
TX80626FMedicare PIN
TX8F1926Medicare PIN
TX8427B7Medicare PIN
TX139425631Medicaid
TX139425641Medicaid
TX010035333Medicare PIN
TX139425614Medicaid
TX139425639Medicaid
TX139425640Medicaid
TX8F0104Medicare PIN
TX8F5136Medicare PIN
TX139425625Medicaid
TX85K117Medicare PIN