Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | M8091 | ID |
NPI | 1013905355 |
---|---|
Provider Name | Dr. Steve Edward Roberts |
First Address | Nampa, ID 83653-1517 |
Second Address | Nampa, ID 83686-6008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F23603 | (02) |