Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 31819 | TX |
Y | 1223D0004X | Dentist Anesthesiologist | D009441 | AZ |
NPI | 1972864528 |
---|---|
Provider Name | Dr. Aaron Legrand Roberts |
First Address | Glendale, AZ 85318-1765 |
Second Address | Mesa, AZ 85210-5030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 07/07/2016 |