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General NPI Number Information
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NPI Number | 1154404952
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Entity Type | Individual
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Provider Name | WILLIAM OLIVER ROBERTS MD
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | UFP PHALEN VILLAGE CLINIC 1414 MARYLAND AVENUE EAST
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City | SAINT PAUL
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State | MN
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Zip | 55106
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Country | US
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Telephone | 651-772-3461
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Fax |
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Provider Business Mailing Address
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Address Line | UNIVERSITY OF MINNESOTA PHYSICIANS 420 DELAWARE STREET SE
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 651-772-3461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24845
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 24845
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License Number State | MN
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