Roberts, John Russell

Roberts, John Russell is an individual health care provider with primary practice located at 409 N 6Th St , Longview TX 75601-6536. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Roberts, John Russell can be contacted via phone (903) 315-5520.

Contact Information

Primary practice address
409 N 6Th St Longview TX 75601-6536
Phone: (903) 315-5520
Fax: (903) 663-6371
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA03743 Texas
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA03743 Texas

Profile Details

NPI number 1568493757
LBN Legal business name Roberts, John Russell
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Nov 19th, 2014 - 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 1568493757 NPPES
Texas Other 81742 BC/BS
Texas Other 5536069 BC/BS

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