Provider Demographics
NPI:1194059071
Name:ROBERSON, TIMOTHY BOYD (PA-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BOYD
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2701
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-2701
Mailing Address - Country:US
Mailing Address - Phone:903-657-7581
Mailing Address - Fax:903-657-1187
Practice Address - Street 1:1309 5TH ST
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-1235
Practice Address - Country:US
Practice Address - Phone:903-504-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L20142OtherMEDICARE PTAN