1477548378 NPI number — JEFFREY S ROBERTS MD

Table of content: JEFFREY S ROBERTS MD (NPI 1477548378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477548378 NPI number — JEFFREY S ROBERTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
JEFFREY
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477548378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 COLONIAL BOULEVARD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-931-7342
Provider Business Mailing Address Fax Number:
239-931-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL DRIVE SUITE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28801-4565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-225-1915
Provider Business Practice Location Address Fax Number:
828-252-5180
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  9900334 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00046512 . This is a "RAILROAD MCARE PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 891191N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4567509 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1191N . This is a "BCBS OF NC PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: A4056 . This is a "MEDCOST PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1168747 . This is a "GATEWAY HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1424836010 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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