Healthcare Provider Details

I. General information

NPI: 1700856044
Provider Name (Legal Business Name): JOHN MARK ROBERTS V M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 BLUE ASH RD
CINCINNATI OH
45242-6822
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT, PHYS DIV 2ND FL, CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-792-7445
  • Fax: 513-791-4042
Mailing address:
  • Phone: 513-792-7445
  • Fax: 513-791-4042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.051646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: