Provider Demographics
NPI:1689648305
Name:ROBERTS, GAYLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:A
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 1:2710 DOLBEER ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8759 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1340
Practice Address - Country:US
Practice Address - Phone:480-795-6722
Practice Address - Fax:602-569-4244
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-34644207RH0003X
AZ22152207RH0003X
KY14507207RH0003X
ORMD28240207RH0003X
AL5506207RH0003X
OK18329207RH0003X
CAC53213207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL156238Medicaid
AZ157877OtherAHCCCS
AZ1689648305OtherDOB: 01/25/1938
AZ830008239OtherRAILROAD MEDICARE
AZZ70784Medicare PIN
AZ157877OtherAHCCCS