Provider Demographics
NPI:1386020089
Name:ROBERTS, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W RIO SALADO PKWY
Mailing Address - Street 2:APARTMENT 51
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3839
Mailing Address - Country:US
Mailing Address - Phone:602-330-8732
Mailing Address - Fax:
Practice Address - Street 1:1301 W RIO SALADO PKWY
Practice Address - Street 2:APARTMENT 51
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3839
Practice Address - Country:US
Practice Address - Phone:602-330-8732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic