Provider Demographics
NPI:1023134756
Name:ROBERTS, LYNNE JEANINE (MD)
Entity type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:JEANINE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8144 WALNUT HILL LN
Mailing Address - Street 2:STE 360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4324
Mailing Address - Country:US
Mailing Address - Phone:469-232-9300
Mailing Address - Fax:
Practice Address - Street 1:8144 WALNUT HILL LN
Practice Address - Street 2:STE 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4324
Practice Address - Country:US
Practice Address - Phone:469-232-9300
Practice Address - Fax:469-232-9850
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8647207N00000X
IN01028675A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX415509OtherPHCS
TX00F78BOtherBCBS
TX4111259OtherAETNA
TXR00879958Medicare ID - Type Unspecified
TX415509OtherPHCS