Provider Demographics
NPI:1649549320
Name:ROBERTS, DEBORAH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-1055
Mailing Address - Country:US
Mailing Address - Phone:802-748-3050
Mailing Address - Fax:
Practice Address - Street 1:2778 LONG VIEW RD
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5071
Practice Address - Country:US
Practice Address - Phone:802-748-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49219208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice