Healthcare Provider Details

I. General information

NPI: 1992755441
Provider Name (Legal Business Name): CARLOS ROBLES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SAINT FRANCIS DR SUITE 372
CAPE GIRARDEAU MO
63703-5049
US

IV. Provider business mailing address

PO BOX 801143
KANSAS CITY MO
64180-1143
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-5525
  • Fax: 573-331-5558
Mailing address:
  • Phone: 573-331-3000
  • Fax: 573-331-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2007035472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: