MEDICARE: DR. LAYNE D. ROBERTS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	O-91	ID

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080177677	OTHER	ID	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010002108	OTHER	ID	BLUE SHIELD OF IDAHO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	S3374	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1902809205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAYNE D. ROBERTS D.O.

Provider Business Mailing Address
First Line	:	2000 AMERICAN LEGION BLVD
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-3138
Country	:	US
Telephone Number	:	208-587-1500
Fax Number	:	208-587-3180

Provider Business Practice Location Address
First Line	:	2000 AMERICAN LEGION BLVD
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-3138
Country	:	US
Telephone Number	:	208-587-1500
Fax Number	:	208-587-3180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/27/2012

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Directions to “ DR. LAYNE D. ROBERTS D.O.” Practice Location

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