Individual
JEFFREY ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 N PEPPER AVE, DEPT. SURGERY MODULAR # 3, COLTON, CA 92324-1801
(909) 580-6210
(909) 580-1363
Mailing address
PO BOX 670, REDLANDS, CA 92373
(909) 747-0371
(909) 307-3287
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G700620
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0079700
—
CA
01
—
ZZZ13858Z
MEDICARE GROUP
CA
Enumeration date
08/25/2006
Last updated
10/01/2008
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