Provider Demographics
NPI:1750386413
Name:ROBERSON, WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:DO
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 489
Mailing Address - Street 2:
Mailing Address - City:MT ENTERPRISE
Mailing Address - State:TX
Mailing Address - Zip Code:75681-0489
Mailing Address - Country:US
Mailing Address - Phone:903-392-8203
Mailing Address - Fax:866-835-6516
Practice Address - Street 1:105 ZEID BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6070
Practice Address - Country:US
Practice Address - Phone:903-315-5615
Practice Address - Fax:903-657-1187
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170727501Medicaid
TX170727501Medicaid
TX8C7913Medicare ID - Type Unspecified