Provider Demographics
NPI:1386899268
Name:DOUGLAS E ROBERTS JR MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DOUGLAS E ROBERTS JR MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-446-4571
Mailing Address - Street 1:900 N HERITAGE DR
Mailing Address - Street 2:BLDG E
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5536
Mailing Address - Country:US
Mailing Address - Phone:760-446-4571
Mailing Address - Fax:
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:BLDG E
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5536
Practice Address - Country:US
Practice Address - Phone:760-446-4571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty