MEDICARE: DR. ANNE ELIZABETH ROBERTS M.D.

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	207R00000X	Internal Medicine Physician	104107	MO

General Provider Information

NPI Number	:	1407086168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE ELIZABETH ROBERTS M.D.

Provider Business Mailing Address
First Line	:	1530 E PRIMROSE ST
Second Line	:	SUITE C
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7928
Country	:	US
Telephone Number	:	417-823-8318
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 E PRIMROSE ST
Second Line	:	SUITE C
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-7928
Country	:	US
Telephone Number	:	417-823-8318
Fax Number	:

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

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	07/15/2009

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