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Individual
MARK D ROBERTS
Active
Individual
MARK D ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02376
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
191296601
—
TX
05
—
191296602
—
TX
05
—
191296603
—
TX
01
—
261742781
TX ID
TX
01
—
8L10914
MEDICARE
TX
01
—
8Y2805
BLUE CROSS BLUE SHIELD OF TEXAS
TX
01
—
8Y9746
BCBS
TX
Enumeration date
04/21/2006
Last updated
07/25/2012
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