Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 01028675A | IN |
Y | 207N00000X | Dermatologist | F8647 | TX |
NPI | 1023134756 |
---|---|
Provider Name | Dr. Lynne Jeanine Roberts |
First Address | Dallas, TX 75231-4324 |
Second Address | Dallas, TX 75231-4324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00F78B | BCBS (01) | TX |
4111259 | AETNA (01) | TX |
415509 | PHCS (01) | TX |
C21126 | (02) | TX |