Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1043678188 |
---|---|
Provider Name | Matthew Roberts |
First Address | Auburn, CA 95603-2854 |
Second Address | Auburn, CA 95603-2854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2016 |
Last Update Date | 03/02/2016 |