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NPI Code Detail

MEDICARE: DR. MICHAEL DEAN ROBERTS PH.D.

MEDICARE: DR. MICHAEL DEAN ROBERTS PH.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
1103TC0700XClinical Psychologist15-174MS

General Provider Information

NPI Number : 1962597708
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL DEAN ROBERTS PH.D.
Provider Business Mailing Address
First Line : 152 HIGHWAY 7 SOUTH
Second Line :
City : OXFORD
State : MS
Zip : 38655-5392
Country : US
Telephone Number : 662-234-7521
Fax Number : 662-346-3071
Provider Business Practice Location Address
First Line : 152 HIGHWAY 7 S
Second Line :
City : OXFORD
State : MS
Zip : 38655-5392
Country : US
Telephone Number : 662-234-7521
Fax Number : 662-346-3071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/08/2007

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