Provider Demographics
NPI:1114948957
Name:ROBERTS, SAMUEL H (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:H
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5880
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85178-0032
Mailing Address - Country:US
Mailing Address - Phone:480-982-0922
Mailing Address - Fax:480-539-2888
Practice Address - Street 1:4111 E VALLEY AUTO DR
Practice Address - Street 2:SUITE 209
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4605
Practice Address - Country:US
Practice Address - Phone:480-982-0922
Practice Address - Fax:480-539-2888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD47142Medicare UPIN
D47142Medicare UPIN