Provider Demographics
NPI:1851755904
Name:ROBERTS, SCOTT BENJAMIN (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BENJAMIN
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 1:1713 OFFNERE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2939
Mailing Address - Country:US
Mailing Address - Phone:951-581-3617
Mailing Address - Fax:855-731-1335
Practice Address - Street 1:1713 OFFNERE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2939
Practice Address - Country:US
Practice Address - Phone:951-581-3617
Practice Address - Fax:855-731-1335
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17060207Q00000X
CA20A17060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine