Healthcare Provider Details

I. General information

NPI: 1982635348
Provider Name (Legal Business Name): SUSAN GILCREASE ROBERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 E 29TH ST STE 200
BRYAN TX
77802-2623
US

IV. Provider business mailing address

2900 E 29TH ST STE 100
BRYAN TX
77802-2623
US

V. Phone/Fax

Practice location:
  • Phone: 979-776-8440
  • Fax: 877-601-5854
Mailing address:
  • Phone: 979-776-8440
  • Fax: 877-601-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH9951
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberH9951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: