Healthcare Provider Details

I. General information

NPI: 1992707723
Provider Name (Legal Business Name): DION M ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 LAKE OTIS PKWY
ANCHORAGE AK
99508-5227
US

IV. Provider business mailing address

PO BOX 110576
ANCHORAGE AK
99511-0576
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-5440
  • Fax: 907-562-0412
Mailing address:
  • Phone: 907-561-5440
  • Fax: 907-562-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberAA0839
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierMD0839
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: