Larry C Roberts, MD

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

E8856 Issued in TX

Practice address

2005 N 2ND Ave Ste D
Canyon, TX 79015-2545

Phone

(806) 510-3376

Fax

(806) 510-3379

NPI assigned

Jun 1, 2005

Last updated

Oct 18, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 13, 2013 through Dec 13, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Palo Duro Dermatology, PLLC

  • Dermatology Physician
  • Canyon, TX
  • NPI 1699120048
  NPD (past) Authorized official
• High Plains Dermatology Center, P.a.

  • Specialist
  • Amarillo, TX
  • NPI 1083667117
  NPD
• Enos Dermatopathology PLLC

  • Dermatopathology Physician
  • Amarillo, TX
  • NPI 1538813696
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476748800000",
    "number": "1578565859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 N 2ND AVE",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790152544",
            "telephone_number": "806-510-3376",
            "fax_number": "806-510-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 N 2ND AVE STE D",
            "city": "CANYON",
            "state": "TX",
            "postal_code": "790152545",
            "telephone_number": "806-510-3376",
            "fax_number": "806-510-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "LARRY",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2016-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "TX",
            "license": "E8856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "037631101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "070002897",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "807985",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla J Price, FNP-C
• Kevin E. Raef, D.C.
• Desiree Redwine
• Liam Rettenmeier, LAT, ATC,EMT
• Robby Douglas Rhodes, MS,ATC,LAT
• Katherine Sheri Rogers, PT
• Virginia Sauer Rojas, MA
• James Rosson, FNP-C
• Lauren Anne Salazar, O.D.
• Brandee Renae Salisbury, APRN, FNP-C

• Dermatopathology Physician in Canyon, TX
• Providers in Canyon, TX by specialty
• Dermatopathology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.