Provider Demographics
NPI:1750374864
Name:ROBERTS, ALFRED D (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:D
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 1:6179 S BALSAM WAY #130
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3092
Mailing Address - Country:US
Mailing Address - Phone:303-948-2020
Mailing Address - Fax:303-904-2020
Practice Address - Street 1:6179 S BALSAM WAY STE 130
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3092
Practice Address - Country:US
Practice Address - Phone:303-948-2020
Practice Address - Fax:303-904-2020
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28763174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01287630Medicaid
CO1188050001OtherDMERC
CO921478OtherBLOCK VISION
COC77011Medicare ID - Type Unspecified
CO1188050001OtherDMERC