Individual
JACOB AARON ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
620 NORTH MAIN, HARRISON, AR 72601-2926
(870) 365-2000
(360) 738-6377
Mailing address
505 S 336TH ST, SUITE 600, FEDERAL WAY, WA 98003-6328
(253) 838-6180
(253) 838-6418
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2008004927
MO
207P00000X
Emergency Medicine Physician
Primary
E-6639
AR
207P00000X
Emergency Medicine Physician
OP00002055
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207212
LIWA
WA
01
—
0207213
LIWA
WA
01
—
1153RO
BSWA
WA
01
—
1771RO
BSWA
WA
05
—
8448532
—
WA
01
—
85490
AR BLUE CROSS
—
Enumeration date
06/12/2006
Last updated
03/12/2025
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