1851357131 NPI number — MARTIN ROBERTS MD

Table of content: MARTIN ROBERTS MD (NPI 1851357131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851357131 NPI number — MARTIN ROBERTS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
MARTIN
Provider Middle Name:
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:
1851357131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MAYFLOWER CT E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMOSASSA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34446-4977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-476-2607
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 EAST BROADWAY
Provider Second Line Business Practice Location Address:
ST ALEXIUS HEALTH
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-530-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2006

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: 207R00000X , with the licence number:  2001-89 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 10452 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME0088383 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30200030 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA121351 . This is a "HARVARD NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 274736700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34097 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01Y013580NH01 . This is a "ANTHEM BC BS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: G1448 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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