Provider Demographics
NPI:1558351551
Name:ROBERTS, RICK N (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:N
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:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-985-1423
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:1375 N HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5280
Practice Address - Country:US
Practice Address - Phone:208-809-2869
Practice Address - Fax:208-809-2870
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8183207R00000X
IDM-8183207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010032233OtherBLUE SHIELD
ID806354700OtherHEALTHY CONNOCTIONS
ID000010032234OtherBLUE SHIELD
ID110221065OtherRAILROAD MEDICARE
ID41996OtherBLUE CROSS
ID806008000Medicaid
ID806008000Medicaid
ID000010032234OtherBLUE SHIELD