Healthcare Provider Details

I. General information

NPI: 1932683653
Provider Name (Legal Business Name): ELIZABETH MARY ROBERTS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S OSTEOPATHY AVE
KIRKSVILLE MO
63501-6401
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-0853
US

V. Phone/Fax

Practice location:
  • Phone: 660-785-1000
  • Fax:
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberT2965
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: