MEDICARE: SUSAN ROBERTS D.O.

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	207Q00000X	Family Medicine Physician	K2574	TX
2	207Q00000X	Family Medicine Physician	A-1723-13	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437158896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ROBERTS D.O.

Provider Business Mailing Address
First Line	:	PO BOX 26028
Second Line	:	CLINICIAN SERVICES
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6028
Country	:	US
Telephone Number	:	505-237-8700
Fax Number	:	505-237-8703

Provider Business Practice Location Address
First Line	:	2050A 2ND ST SE
Second Line	:
City	:	KIRTLAND AFB
State	:	NM
Zip	:	87117-5522
Country	:	US
Telephone Number	:	505-846-3200
Fax Number	:

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	04/07/2021

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Directions to “ SUSAN ROBERTS D.O.” Practice Location

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