Provider Demographics
NPI:1912210105
Name:ROBERTS, ERIC WAYNE (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WAYNE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8027
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-8027
Mailing Address - Country:US
Mailing Address - Phone:800-411-7513
Mailing Address - Fax:817-877-0350
Practice Address - Street 1:1000 S BECKHAM AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1908
Practice Address - Country:US
Practice Address - Phone:903-526-1068
Practice Address - Fax:903-593-4290
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX734134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered