Provider Demographics
NPI:1235346081
Name:ROBERTS, TANA PETERSON (MD)
Entity type:Individual
Prefix:MRS
First Name:TANA
Middle Name:PETERSON
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 N CENTRAL EXPY STE M1025
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1615
Mailing Address - Country:US
Mailing Address - Phone:214-368-6341
Mailing Address - Fax:214-368-5803
Practice Address - Street 1:8350 N CENTRAL EXPY STE M1025
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-1615
Practice Address - Country:US
Practice Address - Phone:214-368-6341
Practice Address - Fax:214-368-5803
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXN2759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program