Healthcare Provider Details

I. General information

NPI: 1649549320
Provider Name (Legal Business Name): DEBORAH ANNE ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2778 LONG VIEW RD
YUCCA VALLEY CA
92284-5071
US

IV. Provider business mailing address

417 CLIFF ST
SAINT JOHNSBURY VT
05819-1055
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-3050
  • Fax:
Mailing address:
  • Phone: 802-748-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG49219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: