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General NPI Number Information
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NPI Number | 1225183791
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Entity Type | Individual
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Provider Name | JERRY WILLIAM MCROBERTS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 37 BALL PARK RD
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City | HARLAN
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State | KY
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Zip | 40831-1701
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Country | US
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Telephone | 606-574-8423
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Fax |
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Provider Business Mailing Address
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Address Line | 37 BALL PARK RD
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City | HARLAN
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State | KY
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Zip | 40831-1701
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Country | US
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Telephone | 606-574-8423
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 16362
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License Number State | KY
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