Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | G2467 | TX |
NPI | 1093881161 |
---|---|
Provider Name | Richard Martin Roberts |
First Address | Corpus Christi, TX 78414-3949 |
Second Address | Corpus Christi, TX 78414-3949 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 21/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
098638203 | (05) | TX |
B56091 | (02) | TX |