Provider Demographics
NPI:1285722165
Name:ROBERTS, JANET LEE (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43541 OLD BARBOUR DRIVE
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1626
Mailing Address - Country:US
Mailing Address - Phone:281-787-8366
Mailing Address - Fax:412-234-5500
Practice Address - Street 1:43541 OLD BARBOUR DRIVE
Practice Address - Street 2:
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-1626
Practice Address - Country:US
Practice Address - Phone:281-787-8366
Practice Address - Fax:412-234-5500
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0174207Q00000X
PAMD446063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88V281Medicare PIN
TXF99091Medicare UPIN