MEDICARE: DR. LYNNE JEANINE ROBERTS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	F8647	TX
2	207N00000X	Dermatology Physician	01028675A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	415509	OTHER	TX	PHCS
2	00F78B	OTHER	TX	BCBS
3	4111259	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1023134756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNE JEANINE ROBERTS M.D.

Provider Business Mailing Address
First Line	:	8144 WALNUT HILL LN
Second Line	:	STE 360
City	:	DALLAS
State	:	TX
Zip	:	75231-4324
Country	:	US
Telephone Number	:	469-232-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	8144 WALNUT HILL LN
Second Line	:	STE 360
City	:	DALLAS
State	:	TX
Zip	:	75231-4324
Country	:	US
Telephone Number	:	469-232-9300
Fax Number	:	469-232-9850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	06/27/2019

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