Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 24845 | MN |
N | 207QS0010X | Family Doctor - Sports Medicine | 24845 | MN |
NPI | 1154404952 |
---|---|
Provider Name | William Oliver Roberts |
First Address | Minneapolis, MN 55455 |
Second Address | Saint Paul, MN 55106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 11/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01-12528 | MEDICA CHOICE (01) | MN |
01-12528 | MEDICA PRIMARY (01) | MN |
0506013 | PREFERRED ONE (01) | MN |
061L6RO | BLUE CROSS BLUE SHIELD (01) | MN |
102775 | UCARE (01) | MN |
1519736 | (05) | IA |
1780296 | ARAZ (01) | MN |
681282100 | (05) | MN |
A95514 | (02) | |
HP17043 | HEALTH PARTNERS (01) | MN |