MEDICARE: DR. CATHLEEN DOMAN ROBERTS DO

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	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	J7161	TX
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	J7161	TX

General Provider Information

NPI Number	:	1346203247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHLEEN DOMAN ROBERTS DO

Provider Business Mailing Address
First Line	:	3001 GEORGE BUSH HWY
Second Line	:	SUITE 250
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3542
Country	:	US
Telephone Number	:	214-343-6663
Fax Number	:	214-343-2814

Provider Business Practice Location Address
First Line	:	12655 N CENTRAL EXPY
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75243-1700
Country	:	US
Telephone Number	:	972-788-1858
Fax Number	:	972-788-2798

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/12/2007

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