Healthcare Provider Details

I. General information

NPI: 1275539090
Provider Name (Legal Business Name): JAMES G ROBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BRIAR HILL RD SUITE A
NORTH BALTIMORE OH
45872-9349
US

IV. Provider business mailing address

745 HASKINS RD SUITE B
BOWLING GREEN OH
43402-1600
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-1417
  • Fax: 419-257-7408
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35056181
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: