MEDICARE: DR. EDWARD BROOKE ROBERTS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	K8969	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200040017	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88772S	OTHER	TX	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174528848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD BROOKE ROBERTS M.D.

Provider Business Mailing Address
First Line	:	12930 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-5710
Country	:	US
Telephone Number	:	713-453-6909
Fax Number	:	713-453-7627

Provider Business Practice Location Address
First Line	:	12930 EAST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-5710
Country	:	US
Telephone Number	:	713-453-6909
Fax Number	:	713-453-7627

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/29/2008

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