Basic Information
| Provider Information | |||||||||
| NPI: | 1053396564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCROBERTS | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | LOWELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 MILLS AVE | ||||||||
| Address2: | SETON SHOAL CREEK HOSPITAL | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787316309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123242080 | ||||||||
| FaxNumber: | 5123243379 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 MILLS AVE | ||||||||
| Address2: | SETON SHOAL CREEK HOSPITAL | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787316309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123242080 | ||||||||
| FaxNumber: | 5123243379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0015X | M6761 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychosomatic Medicine |
ID Information
| ID | Type | State | Issuer | Description | 185666801 | 05 | TX | MEDICAID |