MEDICARE: JACOB AARON ROBERTS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	2008004927	MO
2	207P00000X	Emergency Medicine Physician	OP00002055	WA
3	207P00000X	Emergency Medicine Physician	E-6639	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0207212	OTHER	WA	LIWA
2	1153RO	OTHER	WA	BSWA
3	1771RO	OTHER	WA	BSWA
4	85490	OTHER		AR BLUE CROSS
5	0207213	OTHER	WA	LIWA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265474472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB AARON ROBERTS DO

Provider Business Mailing Address
First Line	:	505 S 336TH ST
Second Line	:	SUITE 600
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-6328
Country	:	US
Telephone Number	:	253-838-6180
Fax Number	:	253-838-6418

Provider Business Practice Location Address
First Line	:	620 NORTH MAIN
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-2926
Country	:	US
Telephone Number	:	870-365-2000
Fax Number	:	360-738-6377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/12/2025

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Directions to “ JACOB AARON ROBERTS DO” Practice Location

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