MEDICARE: DR. LAWRENCE ROBERTS M.D.

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	2086S0127X	Trauma Surgery Physician	21500	WV

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

General Provider Information

NPI Number	:	1598863193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ROBERTS M.D.

Provider Business Mailing Address
First Line	:	7930 FROST ST STE 204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2739
Country	:	US
Telephone Number	:	858-939-3200
Fax Number	:	858-939-9213

Provider Business Practice Location Address
First Line	:	7930 FROST ST STE 204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2739
Country	:	US
Telephone Number	:	858-939-3200
Fax Number	:	858-939-3213

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	02/26/2020

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