Healthcare Provider Details

I. General information

NPI: 1114078763
Provider Name (Legal Business Name): JANET L. ROBERTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST STE 400
PORTLAND OR
97210-2865
US

IV. Provider business mailing address

2525 NW LOVEJOY ST STE 400
PORTLAND OR
97210-2865
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-1933
  • Fax: 503-223-1947
Mailing address:
  • Phone: 503-223-1933
  • Fax: 503-223-1947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD09488
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: