Provider Demographics
NPI:1053382846
Name:ROBERTS, PATRICIA LOIS (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LOIS
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 E. LANCASTER STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-2232
Mailing Address - Country:US
Mailing Address - Phone:817-534-7300
Mailing Address - Fax:817-529-5031
Practice Address - Street 1:2529 E LANCASTER AVE STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-2253
Practice Address - Country:US
Practice Address - Phone:817-534-7300
Practice Address - Fax:817-529-5031
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1186207QG0300X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030510401Medicaid
H28725Medicare UPIN
TX030510401Medicaid