MEDICARE: RICHARD ROBERTS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	5988	NV

General Provider Information

NPI Number	:	1376592386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ROBERTS MD

Provider Business Mailing Address
First Line	:	6301 MOUNTAIN VISTA ST
Second Line	:	SUITE 205
City	:	HENDERSON
State	:	NV
Zip	:	89014-2364
Country	:	US
Telephone Number	:	702-614-5437
Fax Number	:	702-990-9922

Provider Business Practice Location Address
First Line	:	6301 MOUNTAIN VISTA ST
Second Line	:	SUITE 205
City	:	HENDERSON
State	:	NV
Zip	:	89014-2364
Country	:	US
Telephone Number	:	702-614-5437
Fax Number	:	702-990-9922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	07/08/2007

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