MEDICARE: DR. JAMES GREGORY ROBERTS M.D., R.V.T. FACS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD60422790	WA
2	2086S0129X	Vascular Surgery Physician	MD60422790	WA
3	2086S0129X	Vascular Surgery Physician	61178	AZ
4	2086S0129X	Vascular Surgery Physician	MC-0454	ID
5	2086S0129X	Vascular Surgery Physician	CDR.0001339	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4069830	OTHER	TN	BLUE CROSS BLUE SHIELD
3	61178	OTHER	AZ	AZ LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1212093	OTHER	TN	CHA HEALTH
6	TN0101	OTHER	TN	JOHN DEERE HEALTH
7	325383	OTHER	WA	STATE L&I

General Provider Information

NPI Number	:	1356346936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES GREGORY ROBERTS M.D., R.V.T. FACS

Provider Business Mailing Address
First Line	:	1800 15TH ST. STE 220
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631
Country	:	US
Telephone Number	:	970-810-5462
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 FLORIDA AVE STE 305
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95350-4439
Country	:	US
Telephone Number	:	209-575-5833
Fax Number	:	209-575-5836

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/20/2025

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