Provider Demographics
NPI:1366505521
Name:ROBERTS, RICHARD ROYSTON (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROYSTON
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 1:601 RIVER POINTE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2945
Mailing Address - Country:US
Mailing Address - Phone:936-756-7788
Mailing Address - Fax:936-539-5454
Practice Address - Street 1:601 RIVER POINTE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2945
Practice Address - Country:US
Practice Address - Phone:936-756-7788
Practice Address - Fax:936-539-5454
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1253207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000JK976Medicaid
TXC-21138Medicare UPIN
TXP000JK976Medicaid