MEDICARE: BREYTON GAGE ROBERSON

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	171000000X	Military Health Care Provider	45791191	TX

General Provider Information

NPI Number	:	1205710258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREYTON GAGE ROBERSON

Provider Business Mailing Address
First Line	:	1010 8TH ST
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-4830
Country	:	US
Telephone Number	:	979-864-7862
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 8TH ST
Second Line	:
City	:	BAY CITY
State	:	TX
Zip	:	77414-4830
Country	:	US
Telephone Number	:	979-864-7862
Fax Number	:

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

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	08/04/2025

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