Provider Demographics
NPI:1386690006
Name:ROBERTS, RIGGS BAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RIGGS
Middle Name:BAILEY
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 MILL ST STE B
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1236
Mailing Address - Country:US
Mailing Address - Phone:808-242-9233
Mailing Address - Fax:808-249-2546
Practice Address - Street 1:1883 MILL ST STE B
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1236
Practice Address - Country:US
Practice Address - Phone:808-242-9233
Practice Address - Fax:808-249-2546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2024-02-06
Deactivation Date:2024-01-22
Deactivation Code:
Reactivation Date:2024-02-06
Provider Licenses
StateLicense IDTaxonomies
CAG390372084P0800X
HI47532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI4753OtherHAWAII LICENCE #
HI013738-01Medicaid
HI4753OtherHAWAII LICENCE #
HI0000BDKJCMedicare ID - Type UnspecifiedMEDICARE #