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General NPI Number Information
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NPI Number | 1578565859
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Entity Type | Individual
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Provider Name | LARRY C ROBERTS MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 2005 N 2ND AVE STE D
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City | CANYON
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State | TX
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Zip | 79015-2545
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Country | US
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Telephone | 806-510-3376
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Fax | 806-510-3379
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Provider Business Mailing Address
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Address Line | 2005 N 2ND AVE
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City | CANYON
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State | TX
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Zip | 79015-2544
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Country | US
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Telephone | 806-510-3376
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Fax | 806-510-3379
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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 | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | E8856
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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