Individual ProviderTyler RoubidouxAnesthesiologyAllopathic & Osteopathic PhysiciansPractice Address101 W 8th Ave, Spokane, WA 99204-2307(509) 474-3020(626) 204-6747PECOS EnrollmentBased on the most recent information from CMS, provider Tyler Roubidoux is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1609133800Provider TypeIndividualFull NameRoubidoux, TylerGenderMaleSole ProprietorYesEnumeration Date4/12/2012Last Updated8/8/2016Contact InformationPractice LocationPractice Address101 W 8th Ave, Spokane, WA 99204-2307Phone(509) 474-3020FaxUnlisted FaxMailing LocationMailing AddressPO Box 60790, Pasadena, CA 91116-6790Phone(626) 204-6747Fax(626) 396-0851Provider TaxonomiesCodeDescriptionLicenseCode207L00000XPrimaryDescriptionAnesthesiologyAllopathic & Osteopathic PhysiciansLicenseA127481CaliforniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer