Healthcare Provider Details

I. General information

NPI: 1073737144
Provider Name (Legal Business Name): ZACHARY V ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 E 39TH ST S STE 410
INDEPENDENCE MO
64057-2307
US

IV. Provider business mailing address

19550 E 39TH ST S STE 410
INDEPENDENCE MO
64057-2307
US

V. Phone/Fax

Practice location:
  • Phone: 816-303-2400
  • Fax: 816-303-2497
Mailing address:
  • Phone: 816-303-2400
  • Fax: 816-303-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2017005393
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: