Healthcare Provider Details

I. General information

NPI: 1578851374
Provider Name (Legal Business Name): HEATHER R ROBERTS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BETHANY HOME RD
PHOENIX AZ
85015-2443
US

IV. Provider business mailing address

5791 W DUBLIN LN
CHANDLER AZ
85226-1854
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-5747
  • Fax:
Mailing address:
  • Phone: 480-234-9513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number006685
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: