Healthcare Provider Details

I. General information

NPI: 1609936293
Provider Name (Legal Business Name): CHRISTOPHER H. ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 DAVIS BLVD STE 1
JOPLIN MO
64804-3278
US

IV. Provider business mailing address

8458 CEDAR DR
JOPLIN MO
64804-8435
US

V. Phone/Fax

Practice location:
  • Phone: 417-622-0911
  • Fax: 417-622-0730
Mailing address:
  • Phone: 417-434-1229
  • Fax: 417-622-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number04-34426
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number106994
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number106994
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: