Provider Demographics
NPI:1902226814
Name:WILLIAM BOYD ROBERSON JR, DO PC
Entity Type:Organization
Organization Name:WILLIAM BOYD ROBERSON JR, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:903-738-1623
Mailing Address - Street 1:8511 FM 856 N
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-8073
Mailing Address - Country:US
Mailing Address - Phone:903-738-1623
Mailing Address - Fax:
Practice Address - Street 1:8511 FM 856 N
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789-8073
Practice Address - Country:US
Practice Address - Phone:903-738-1623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170727501Medicaid
TX170727501Medicaid