Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | G62500 | CA |
N | 208200000X | Surgeon | G62500 | CA |
N | 208600000X | Surgeon | G62500 | CA |
NPI | 1437113446 |
---|---|
Provider Name | Dr. John P. Roberts |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0G6250000 | (05) | CA |
E75088 | (02) | CA |