Healthcare Provider Details

I. General information

NPI: 1538097555
Provider Name (Legal Business Name): DR. GREGORY DALTON ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 FAIRMOUNT ST # 157
WICHITA KS
67260-0001
US

IV. Provider business mailing address

1845 FAIRMOUNT ST # 157
WICHITA KS
67260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 316-978-8350
  • Fax:
Mailing address:
  • Phone: 316-978-8350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: