Organization
PALO DURO DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY C ROBERTS MD (OWNER)
(806) 553-0185
Entity
Organization
Contact information
Practice address
2005 N 2ND AVE STE D, CANYON, TX 79015-2545
(806) 553-0185
(806) 853-6630
Mailing address
PO BOX 1638, CANYON, TX 79015-1638
(806) 488-2176
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D2117683
CLIA
TX
Enumeration date
05/03/2016
Last updated
10/02/2016
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