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General NPI Number Information
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NPI Number | 1710252705
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Entity Type | Individual
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Provider Name | EDWARD ROY ROBERTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2012
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 20518 LAVERTON DR
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City | KATY
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State | TX
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Zip | 77450-2013
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Country | US
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Telephone | 281-578-7787
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Fax | 281-578-7787
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Provider Business Mailing Address
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Address Line | 20518 LAVERTON DR
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City | KATY
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State | TX
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Zip | 77450-2013
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Country | US
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Telephone | 281-578-7787
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Fax | 281-578-7787
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | D1029
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License Number State | TX
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