EDWIN D ROBERTSON (NPI# 1649200700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649200700 |
| Entity Type | Individual |
| Full Name | EDWIN D ROBERTSON |
| Credential | PHD |
| Practice Address |
701 Olympic Plaza Cir Tyler TX 75701-1950 |
| Mailing Address |
Po Box 9477 Tyler TX 75711-9477 |
| Practice Telephone | 9035963000 |
| Practice Fax Number | 9035963006 |
| Mailing Telephone | 9035942450 |
| Mailing Fax Number | 9035090493 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-12-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 24420 | TX | Behavioral Health & Social Service Providers |
| N | 103T00000X | Psychologist | 24420 | TX | Behavioral Health & Social Service Providers |
| Street Address |
701 OLYMPIC PLAZA CIR |
| City | TYLER |
| State | TX |
| Zip Code | 75701-1950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841232964 | Virgilio V Gonzalez | Pathology | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2006-06-12 |
| 1356977847 | Tammy Mallard | Occupational Therapy Assistant | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-17 |
| 1255967642 | Stacy Betts Dickerson | Speech-Language Pathologist | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-17 |
| 1053947440 | Joseph Clinton Staples | Occupational Therapist | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-17 |
| 1942836341 | Lynn Allison Henry | Physical Therapist | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-17 |
| 1942836366 | Sheila Diaz | Physical Therapist | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-17 |
| 1023644614 | Mark Roland Saczek | Physical Therapist | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-16 |
| 1578199162 | Kathy E Kizer | Physical Therapist | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-16 |
| 1003442773 | Vicki Lynne Walter | Physical Therapy Assistant | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-13 |
| 1336775014 | Katherine Sue Henke | Physical Medicine & Rehabilitation | 701 Olympic Plaza Cir, Tyler, TX 75701-1950 | 2020-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013450220 | Frederick Gary Mears | Clinical Neuropsychologist | 1810 Shiloh Rd Ste 801, Tyler, TX 75703-2457 | 2016-11-21 |
| 1144596792 | Tina Marie Borke | Clinical Neuropsychologist | 719 West Front St., Tyler, TX 75702 | 2012-03-28 |
| 1497805659 | Robert Sperry Jr. | Clinical Neuropsychologist | 605 Chase Dr, Suite 2, Tyler, TX 75701-9431 | 2007-01-11 |
| 1619044856 | Barry Wilson Rath | Clinical Neuropsychologist | 826 S Fleishel Ave, Tyler, TX 75701-2016 | 2006-11-30 |
| 1144233297 | Stephen Kelly Martin | Clinical Neuropsychologist | 3800 Paluxy Dr, Suite 450, Tyler, TX 75703-1629 | 2006-08-13 |
| 1326657792 | Pelin D Strebler | Clinical Neuropsychologist | 11937 Us Highway 271, Tyler, TX 75708-3154 | 2020-07-30 |
| 1356573414 | Martin Neurobehavioral Center, PC | Clinical Neuropsychologist | 3800 Paluxy Dr, Suite 450, Tyler, TX 75703-1629 | 2009-08-21 |
| 1609068071 | Charles Raymond Walker | Clinical Neuropsychologist | 2737 S Broadway Ave, Tyler, TX 75701 | 2007-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598375487 | Tara Austin | Clinical Neuropsychologist | 4900 Bagby Ave Apt 819, Waco, TX 76711-0035 | 2020-08-05 |
| 1215557400 | Amy Elizabeth Werry | Clinical Neuropsychologist | 7703 Floyd Circle Drive, San Antonio, TX 78229 | 2020-04-17 |
| 1992330864 | Annelizabeth Robinson Carlew | Clinical Neuropsychologist | 6333 Forest Park Rd 1st Fl Bla.100, Dallas, TX 75390-5461 | 2020-03-11 |
| 1710511753 | Gulf Coast Neuropsychology, Pllc | Clinical Neuropsychologist | 1110 Nasa Pkwy Ste 108c, Houston, TX 77058-3351 | 2020-02-28 |
| 1356988372 | Jennifer Reynolds | Clinical Neuropsychologist | 8005 Canyon Parke Ct, Austin, TX 78726-4029 | 2019-12-09 |
| 1649835216 | Kaleidoscope Counseling and Assessment | Clinical Neuropsychologist | 1705 S Capital of Texas Hwy Ste 130, Austin, TX 78746-6587 | 2019-05-08 |
| 1104392067 | Neuropsychological Services of Texarkana Pllc | Clinical Neuropsychologist | 5411 Plaza Dr Ste E, Texarkana, TX 75503-1667 | 2018-10-18 |
| 1801370184 | Professional Exam Services Inc. | Clinical Neuropsychologist | 2233 E Grauwyler Rd Ste 107, Irving, TX 75061-3239 | 2018-09-21 |
| 1255815072 | Seema Pandya | Clinical Neuropsychologist | 9101 N Central Expy Ste 230, Dallas, TX 75231-6079 | 2018-09-18 |
| 1972097145 | Juliette Galindo | Clinical Neuropsychologist | 1333 Moursund Ave, Psychology/neuropsychology H124, Houston, TX 77030-3405 | 2018-06-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.