Basic Information
| Provider Information | |||||||||
| NPI: | 1700826260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 HOSPITAL PKWY STE 204 | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760225936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177848268 | ||||||||
| FaxNumber: | 8172838003 | ||||||||
| Practice Location | |||||||||
| Address1: | 1615 HOSPITAL PKWY STE 204 | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760225936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177848268 | ||||||||
| FaxNumber: | 8172838003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 06/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | K9888 | TX | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 042921902 | 05 | TX | MEDICAID |