Provider Demographics
NPI:1023287794
Name:D'LORM, ROBERTO B (GNP-BC)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:B
Last Name:D'LORM
Suffix:
Gender:M
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 OUTPOST TRCE
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-6456
Mailing Address - Country:US
Mailing Address - Phone:512-364-8494
Mailing Address - Fax:512-267-1362
Practice Address - Street 1:4032 OUTPOST TRCE
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-6456
Practice Address - Country:US
Practice Address - Phone:512-364-8494
Practice Address - Fax:512-267-1362
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672526363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX672526OtherGNP LICENSE