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NPI Code Detail

MEDICARE: GAVIN ROBERTS MD

MEDICARE: GAVIN ROBERTS MD
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
1207W00000XOphthalmology Physician01043662AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477555035
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAVIN ROBERTS MD
Provider Business Mailing Address
First Line : 550 UNIVERSITY BLVD
Second Line : SUITE 3080
City : INDIANAPOLIS
State : IN
Zip : 46202-5149
Country : US
Telephone Number : 317-274-1034
Fax Number : 317-274-3265
Provider Business Practice Location Address
First Line : 702 BARNHILL DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5128
Country : US
Telephone Number : 317-274-8103
Fax Number : 317-274-1111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 05/06/2008

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