Individual
SUSAN ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5522
(505) 846-3200
Mailing address
PO BOX 26028, CLINICIAN SERVICES, ALBUQUERQUE, NM 87125-6028
(505) 237-8700
(505) 237-8703
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A-1723-13
NM
207Q00000X
Family Medicine Physician
K2574
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00002166
—
NM
05
—
153862101
—
TX
Enumeration date
07/19/2005
Last updated
04/07/2021
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