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General NPI Number Information
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NPI Number | 1164526349
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Entity Type | Individual
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Provider Name | ROBERT ANSLEY ROOF III D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/19/2009
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Provider Practice Location Address
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Address Line | 3421 WEST 9TH ST
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City | WATERLOO
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State | IA
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Zip | 50702
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Country | US
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Telephone | 800-458-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 20706 247TH ST
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City | DELHI
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State | IA
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Zip | 52223-8416
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Country | US
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Telephone | 563-927-5529
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 02246
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License Number State | IA
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