Provider Demographics
NPI:1861499261
Name:ROBERTS, JAMES G (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MERION DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3282
Mailing Address - Country:US
Mailing Address - Phone:806-438-4550
Mailing Address - Fax:
Practice Address - Street 1:2000 LAMAR BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:682-227-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8174207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87615OtherPRESBYTERIAN COMMERCIAL
TX8M0233OtherBC/BS
TX87766ZOtherHMO BLUE
TX139201100OtherFIRSTCARE COMMERCIAL
NM87615Medicaid
TX139201101Medicaid
TX166672901Medicaid
OK200032510AMedicaid
NM71734252Medicaid
C004OtherTRIWEST
TX8C1586Medicare ID - Type Unspecified
NM71734252Medicaid