Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | C40665 | CA |
NPI | 1003874108 |
---|---|
Provider Name | Dr. Jay D Roberts |
First Address | Palm Desert, CA 92211-3406 |
Second Address | Palm Desert, CA 92211-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C406650 | BLUE SHIELD OF CA (01) | CA |
A37424 | (02) | CA |