MEDICARE: CARL RAY ROBERTS M.D.

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	208D00000X	General Practice Physician	25852	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770582207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL RAY ROBERTS M.D.

Provider Business Mailing Address
First Line	:	1856 E INNOVATION PARK DR
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-1963
Country	:	US
Telephone Number	:	520-825-7111
Fax Number	:	520-818-1253

Provider Business Practice Location Address
First Line	:	1856 E INNOVATION PARK DR
Second Line	:
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-1963
Country	:	US
Telephone Number	:	520-825-7111
Fax Number	:	520-818-1253

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/13/2015

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