Provider Demographics
NPI:1710907001
Name:ROBEY, ROBERT VERSAL (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:VERSAL
Last Name:ROBEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 MAPLEWOOD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3879
Mailing Address - Country:US
Mailing Address - Phone:940-696-8500
Mailing Address - Fax:940-696-8546
Practice Address - Street 1:4301 MAPLEWOOD AVE
Practice Address - Street 2:STE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3879
Practice Address - Country:US
Practice Address - Phone:940-696-8500
Practice Address - Fax:940-696-8546
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00064363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA00064OtherTX PA LICENSE
TXPA00064OtherTX PA LICENSE
TX82N124Medicare ID - Type UnspecifiedMEDICARE PROVIDER #