MEDICARE: DR. JESSE ANDREW 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	R5B16	MO

General Provider Information

NPI Number	:	1811011570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSE ANDREW ROBERTS M.D.

Provider Business Mailing Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:	NORTHCARE HOSPICE
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3221
Country	:	US
Telephone Number	:	816-691-5119
Fax Number	:	816-346-7119

Provider Business Practice Location Address
First Line	:	2900 CLAY EDWARDS DR
Second Line	:	NORTHCARE HOSPICE
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-3221
Country	:	US
Telephone Number	:	816-691-5119
Fax Number	:	816-346-7119

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/02/2010

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