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General NPI Number Information
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NPI Number | 1194059071
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Entity Type | Individual
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Provider Name | TIMOTHY BOYD ROBERSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1309 5TH ST
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City | ARGYLE
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State | TX
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Zip | 76226-1235
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Country | US
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Telephone | 903-504-4587
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2701
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City | LONGVIEW
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State | TX
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Zip | 75606-2701
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Country | US
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Telephone | 903-657-7581
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Fax | 903-657-1187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA06374
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License Number State | TX
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