MEDICARE: DR. LOUIE SANFORD 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	174400000X	Specialist	K6268	TX

General Provider Information

NPI Number	:	1528053741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIE SANFORD ROBERTS M.D.

Provider Business Mailing Address
First Line	:	3333 BAYSHORE BLVD
Second Line	:	SUITE 300
City	:	PASADENA
State	:	TX
Zip	:	77504-1952
Country	:	US
Telephone Number	:	713-944-0229
Fax Number	:	713-946-9448

Provider Business Practice Location Address
First Line	:	3333 BAYSHORE BLVD
Second Line	:	SUITE 300
City	:	PASADENA
State	:	TX
Zip	:	77504-1952
Country	:	US
Telephone Number	:	713-944-0229
Fax Number	:	713-946-9448

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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