Provider Demographics
NPI:1801816962
Name:ROBERSON, ERIC DWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DWAYNE
Last Name:ROBERSON
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 1:315 HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-7303
Mailing Address - Country:US
Mailing Address - Phone:832-868-9313
Mailing Address - Fax:832-422-9393
Practice Address - Street 1:315 HUGHES RD
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-7303
Practice Address - Country:US
Practice Address - Phone:832-868-9313
Practice Address - Fax:832-422-9393
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2109207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1801816962OtherTRICARE
TX141210808Medicaid
TX179249101Medicaid
TX141210807Medicaid
TX141210809Medicaid
TX1801816962OtherBCBSTX
TX8L13334Medicare PIN
TX8L13333Medicare PIN
TXG98976Medicare UPIN
TX179249101Medicaid
TX8F1844Medicare ID - Type Unspecified
TX00892ZMedicare ID - Type Unspecified
TX1801816962Medicare PIN
TX141210809Medicaid