Individual
LARRY C ROBERTS
Active
Individual
LARRY C ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207ND0900X
Dermatopathology Physician
Primary
E8856
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037631101
—
TX
01
—
070002897
MEDICARE RAILROAD
TX
01
—
807985
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/01/2005
Last updated
10/18/2016
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