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Individual
MR. JOHN RUSSELL ROBERTS
Active
Individual
MR. JOHN RUSSELL ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA03743
TX
363AS0400X
Surgical Physician Assistant
PA03743
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5536069
AETNA
TX
01
—
81742
BC/BS
TX
Enumeration date
07/05/2006
Last updated
11/19/2014
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