MEDICARE: REAGAN ROBLES

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	207P00000X	Emergency Medicine Physician	T4043	TX
2	207P00000X	Emergency Medicine Physician	390200000	OK

General Provider Information

NPI Number	:	1760922025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REAGAN ROBLES

Provider Business Mailing Address
First Line	:	1082 WOODBRIAR DR
Second Line	:
City	:	GRAPEVINE
State	:	TX
Zip	:	76051-7817
Country	:	US
Telephone Number	:	214-668-6378
Fax Number	:

Provider Business Practice Location Address
First Line	:	3095 KINGSWOOD BLVD
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75052-4512
Country	:	US
Telephone Number	:	972-854-0009
Fax Number	:

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

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	02/05/2026

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Directions to “ REAGAN ROBLES ” Practice Location

Language	Start Address	Practice Location

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