Healthcare Provider Details

I. General information

NPI: 1942352604
Provider Name (Legal Business Name): JAIME D ROBLEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21830 KINGSLAND BLVD STE 102
KATY TX
77450
US

IV. Provider business mailing address

21830 KINGSLAND BLVD STE 102
KATY TX
77450-2500
US

V. Phone/Fax

Practice location:
  • Phone: 281-717-4902
  • Fax: 281-944-9380
Mailing address:
  • Phone: 281-717-4902
  • Fax: 281-944-9380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberK6916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: