Healthcare Provider Details

I. General information

NPI: 1831786102
Provider Name (Legal Business Name): BETHANY A. ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E 11TH AVE
EUGENE OR
97401-3746
US

IV. Provider business mailing address

501 S CHIPETA WAY RM 1000
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 458-205-7000
  • Fax: 458-205-7022
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD231774
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13521405-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: