MEDICARE: DR. BRUCE ALLEN ROBERTS MD

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	207Q00000X	Family Medicine Physician	14557	AZ
2	2084P0800X	Psychiatry Physician	14557	AZ
3	2084P0800X	Psychiatry Physician	C53920	CA
4	207Q00000X	Family Medicine Physician	C53920	CA

General Provider Information

NPI Number	:	1912940305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE ALLEN ROBERTS MD

Provider Business Mailing Address
First Line	:	2443 FILLMORE ST # 380-3991
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1814
Country	:	US
Telephone Number	:	415-964-0546
Fax Number	:	888-861-2143

Provider Business Practice Location Address
First Line	:	2443 FILLMORE ST # 380-3991
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1814
Country	:	US
Telephone Number	:	415-964-0546
Fax Number	:	888-861-2143

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/21/2022

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