Provider Demographics
NPI:1831123900
Name:ROBERTS, DENNIS FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:FRANK
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81767 DR. CARREON BLVD SUITE 200
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-342-6407
Mailing Address - Fax:760-347-4617
Practice Address - Street 1:81767 DR CARREON BLVD
Practice Address - Street 2:STE 200
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5599
Practice Address - Country:US
Practice Address - Phone:760-342-6407
Practice Address - Fax:760-347-4617
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6099207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX60990Medicaid
CA0020A60990Medicare ID - Type Unspecified
E91041Medicare UPIN