Healthcare Provider Details

I. General information

NPI: 1083698062
Provider Name (Legal Business Name): DOUGLAS ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY AVE STE 230 SUITE 230
SACRAMENTO CA
95825-6524
US

IV. Provider business mailing address

500 UNIVERSITY AVE STE 230 SUITE 230
SACRAMENTO CA
95825-6524
US

V. Phone/Fax

Practice location:
  • Phone: 916-565-1989
  • Fax: 916-646-4036
Mailing address:
  • Phone: 916-565-1989
  • Fax: 916-646-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG56980
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: