Healthcare Provider Details

I. General information

NPI: 1669434106
Provider Name (Legal Business Name): JUSTIN KURT ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

IV. Provider business mailing address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-0800
  • Fax: 406-222-7606
Mailing address:
  • Phone: 406-222-0800
  • Fax: 406-222-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM0244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: