Healthcare Provider Details

I. General information

NPI: 1154683472
Provider Name (Legal Business Name): JEAN L. ROBERTS, M.D., FAMILY MEDICINE & OBSTETRIC CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W UNIVERSITY AVE
MUNCIE IN
47303-3863
US

IV. Provider business mailing address

804 W UNIVERSITY AVE
MUNCIE IN
47303-3863
US

V. Phone/Fax

Practice location:
  • Phone: 765-760-2840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01067670A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01067670A
License Number StateIN

VIII. Authorized Official

Name: DR. JEAN LANGLEY ROBERTS
Title or Position: MEMBER/M.D.
Credential: M.D.
Phone: 765-760-2840