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General NPI Number Information
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NPI Number | 1265474472
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Entity Type | Individual
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Provider Name | JACOB AARON ROBERTS DO
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Gender | Male
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 620 NORTH MAIN
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City | HARRISON
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State | AR
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Zip | 72601-2926
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Country | US
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Telephone | 870-365-2000
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Fax | 360-738-6377
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Provider Business Mailing Address
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Address Line | 505 S 336TH ST SUITE 600
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City | FEDERAL WAY
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State | WA
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Zip | 98003-6328
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Country | US
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Telephone | 253-838-6180
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Fax | 253-838-6418
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2008004927
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | OP00002055
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | E-6639
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License Number State | AR
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