| Doctor Name: | DR. AMANDA MICHELLE ROBERTS |
| NPI Number: | 1174947220 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 0101259069 |
| Business Practice Address: | 2200 Bengquist Ste 1 59 Mdsp/sgmd Jbsa Lackland, TX - 782369908 |
| Business Phone Number: | 2102923376 |
| Business Fax Number: | 2102923781 |
| Mailing Address: | 2200 Bengquist Ste 1, 59 Mdsp/sgmd JBSA LACKLAND |
| State: | TX |
| Postal Code: | 782369908 |
| Phone Number: | 2102923376 |
| Fax Number: | 2102923781 |
| NPI Enumeration Date: | 02/10/2014 |
| NPI Last Update Date: | 09/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101259069 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |