Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | L1186 | TX |
N | 207QG0300X | Family Doctor - Geriatric Medicine | L1186 | TX |
NPI | 1053382846 |
---|---|
Provider Name | Dr. Patricia Lois Roberts |
First Address | Fort Worth, TX 76103-2232 |
Second Address | Fort Worth, TX 76103-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030510401 | (05) | TX |
H28725 | (02) |