Healthcare Provider Details

I. General information

NPI: 1689648305
Provider Name (Legal Business Name): GAYLE A ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8759 E BELL RD
SCOTTSDALE AZ
85260-1340
US

IV. Provider business mailing address

2710 DOLBEER ST
EUREKA CA
95501-4736
US

V. Phone/Fax

Practice location:
  • Phone: 480-795-6722
  • Fax: 602-569-4244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-34644
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number22152
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14507
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD28240
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5506
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18329
License Number StateOK
# 7
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC53213
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: