Provider Demographics
NPI:1962701110
Name:ROBERTS, TONI KAY (MD, PHD)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:KAY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 10TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6331
Mailing Address - Country:US
Mailing Address - Phone:360-598-7500
Mailing Address - Fax:253-382-8545
Practice Address - Street 1:19500 10TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6331
Practice Address - Country:US
Practice Address - Phone:360-598-7500
Practice Address - Fax:253-382-8545
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60385964207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2018700Medicaid