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General NPI Number Information
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NPI Number | 1629494935
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Entity Type | Individual
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Provider Name | JARED ELDON ROBERTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1100 WILFORD HALL LOOP BLDG 4554
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-5638
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Country | US
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Telephone | 210-292-6255
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Fax | 210-292-7934
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP
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City | SAN ANTONIO
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State | TX
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Zip | 78236-5638
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Country | US
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Telephone | 210-292-8808
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Fax |
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | S5483
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | S5483
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | S5483
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License Number State | TX
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