Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G56980 | CA |
NPI | 1083698062 |
---|---|
Provider Name | Dr. Douglas Roberts |
First Address | Sacramento, CA 95825-6524 |
Second Address | Sacramento, CA 95825-6524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2005 |
Last Update Date | 08/07/2007 |