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General NPI Number Information
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NPI Number | 1801931902
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Entity Type | Organization
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Legal Business Name | MICHAEL A ROBERTS MD INC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 923 22ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90403-3403
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Country | US
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Telephone | 310-559-8276
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Fax | 310-559-8284
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Provider Business Mailing Address
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Address Line | 923 22ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90403-3403
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Country | US
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Telephone | 310-559-8276
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Fax | 310-559-8284
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL ALLAN ROBERTS
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Credential | MD
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Telephone | 310-559-8276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G78949
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License Number State | CA
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