MEDICARE: LYNNE J. ROBERTS, M.D., P. A.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4111259	OTHER	AETNA
2	415509	OTHER	PHCS
3	00F78B	OTHER	BCBS
4	C21126	OTHER	UPIN

General Provider Information

NPI Number	:	1104004357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNNE J. ROBERTS, M.D., P. A.

Provider Business Mailing Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	SUITE 330
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	469-232-9300
Fax Number	:	469-232-9850

Provider Business Practice Location Address
First Line	:	7502 GREENVILLE AVE
Second Line	:	SUITE 330
City	:	DALLAS
State	:	TX
Zip	:	75231-3832
Country	:	US
Telephone Number	:	469-232-9300
Fax Number	:	469-232-9850

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYNNE J. ROBERTS
Credential	:	M.D.
Telephone Number	:	469-232-9300

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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