Individual
DR. ALISA ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1250 S WASHINGTON ST, PHOENIX EMERGENCY PHYSICIANS OF THE MIDWEST, VAN WERT, OH 45891-2551
(419) 238-8611
Mailing address
4425 SMITH STEWART RD, VIENNA, OH 44473-9619
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34008346
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522415
ANTHEM
OH
01
—
000000537055
ANTHEM
OH
05
—
2621265
—
OH
Enumeration date
12/06/2005
Last updated
10/28/2010
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