Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A160201 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD61071143 | WA |
NPI | 1093133944 |
---|---|
Provider Name | Jesse Lorin Roberts |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-2570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2014 |
Last Update Date | 13/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093133944 | (05) | WA |