Healthcare Provider Details

I. General information

NPI: 1053313759
Provider Name (Legal Business Name): WILLIAM LINCOLN ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL, CAMP PENDLETON BLDG H100, SANTA MARGARITA ROAD
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

4315 SUNNYHILL DR
CARLSBAD CA
92008-3657
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1398
  • Fax:
Mailing address:
  • Phone: 760-720-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG47779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: