Healthcare Provider Details

I. General information

NPI: 1003871690
Provider Name (Legal Business Name): ROBERT I. PRINCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E COUNTY LINE RD SUITE 201
GREENWOOD IN
46143-1073
US

IV. Provider business mailing address

8805 N MERIDIAN ST
INDIANAPOLIS IN
46260-2760
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-7246
  • Fax: 317-706-3419
Mailing address:
  • Phone: 317-706-7246
  • Fax: 317-706-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number0101234699
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01068883A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: