Healthcare Provider Details

I. General information

NPI: 1801849567
Provider Name (Legal Business Name): HEIDI ROEBER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST STE 520
PHOENIX AZ
85006-2849
US

IV. Provider business mailing address

2905 W WARNER RD STE 23
CHANDLER AZ
85224-1674
US

V. Phone/Fax

Practice location:
  • Phone: 602-839-4456
  • Fax: 602-839-3182
Mailing address:
  • Phone: 602-772-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number48346
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number48346
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: