Provider Demographics
NPI:1942223706
Name:ROBERTS, CORY ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ANTHONY
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 1:1355 RIVER BEND DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4915
Mailing Address - Country:US
Mailing Address - Phone:214-638-2000
Mailing Address - Fax:214-631-6724
Practice Address - Street 1:1355 RIVER BEND DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4915
Practice Address - Country:US
Practice Address - Phone:214-638-2000
Practice Address - Fax:214-631-6724
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0914207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S9353OtherBCBS 99
TX220031778OtherRAILROAD MEDICARE
TX8F2911OtherBCBS DALLAS
TX148590601Medicaid
TX148590602Medicaid
TX8F2911OtherBCBS DALLAS
TX220031778OtherRAILROAD MEDICARE
TX8736K3Medicare ID - Type UnspecifiedLOCALITY 11