Provider Demographics
NPI:1073953238
Name:ROBERTS, AUDREY JEAN (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:JEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ROBERTS
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1100 N SAN FRANCISCO ST STE B
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3260
Mailing Address - Country:US
Mailing Address - Phone:928-779-7851
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:1100 N SAN FRANCISCO ST STE B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3260
Practice Address - Country:US
Practice Address - Phone:928-779-7851
Practice Address - Fax:928-213-9990
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10180297-1205207V00000X
NV20203207V00000X
AZ65391207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty