Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 2339 | AZ |
NPI | 1740256577 |
---|---|
Provider Name | Dr. Bernice Roberts |
First Address | Tucson, AZ 85719-3841 |
Second Address | Tucson, AZ 85719-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 08/07/2007 |