Provider Demographics
NPI:1912940305
Name:ROBERTS, BRUCE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ALLEN
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 1:2443 FILLMORE ST # 380-3991
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1814
Mailing Address - Country:US
Mailing Address - Phone:415-964-0546
Mailing Address - Fax:888-861-2143
Practice Address - Street 1:2443 FILLMORE ST # 380-3991
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1814
Practice Address - Country:US
Practice Address - Phone:415-964-0546
Practice Address - Fax:888-861-2143
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14557207Q00000X, 2084P0800X
CAC539202084P0800X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF23669Medicare UPIN