Basic Information
| Provider Information | |||||||||
| NPI: | 1962701110 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | TONI | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | MD, PHD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 19500 10TH AVE NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605987500 | ||||||||
| FaxNumber: | 2533828545 | ||||||||
| Practice Location | |||||||||
| Address1: | 19500 10TH AVE NE STE 100 | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605987500 | ||||||||
| FaxNumber: | 2533828545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2011 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD60385964 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | MD60385964 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2018700 | 05 | WA | MEDICAID |