Provider Demographics
NPI:1790339273
Name:ROBERTS, JAMES MORRIS
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MORRIS
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 1:706 N COLLEGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5824
Mailing Address - Country:US
Mailing Address - Phone:208-391-5952
Mailing Address - Fax:877-409-2920
Practice Address - Street 1:706 N COLLEGE RD STE C
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5824
Practice Address - Country:US
Practice Address - Phone:208-391-5952
Practice Address - Fax:877-409-2920
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant