Roberts, Mark D

Roberts, Mark D is an individual health care provider with primary practice located at 1201 Hewitt Dr Ste 203 , Waco TX 76712-8834. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Roberts, Mark D can be contacted via phone (254) 666-3627.

Contact Information

Primary practice address
1201 Hewitt Dr Ste 203 Waco TX 76712-8834
Phone: (254) 666-3627
Fax: (254) 732-6125
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA02376 Texas

Profile Details

NPI number 1497711105
LBN Legal business name Roberts, Mark D
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 21st, 2006
Last updated Jul 25th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497711105 NPPES
Texas MEDICAID 191296602
Texas Other 8Y9746
Texas MEDICAID 191296603
Texas Other 261742781
Texas Other 8Y2805
Texas Other 8L10914
Texas MEDICAID 191296601

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