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NPI Code Detail

MEDICARE: DAVID EUGENE ROBERTS MD

MEDICARE: DAVID EUGENE 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
1207Q00000XFamily Medicine Physician10295TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19240OTHERTNTLC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33031752OTHERTNBLUE CROSS BLUE SHIELD TN
47814407OTHERTNCIGNA
5118312OTHERTNBETTER HEALTH

General Provider Information

NPI Number : 1831167295
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID EUGENE ROBERTS MD
Provider Business Mailing Address
First Line : 294 SUMMAR DR
Second Line : DEPT 289
City : JACKSON
State : TN
Zip : 38301-3915
Country : US
Telephone Number : 731-265-8220
Fax Number : 731-265-8355
Provider Business Practice Location Address
First Line : 294 SUMMAR DR
Second Line :
City : JACKSON
State : TN
Zip : 38301-3915
Country : US
Telephone Number : 731-423-1932
Fax Number : 731-423-4919
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2006
Last Update Date : 07/12/2007

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Directions to “ DAVID EUGENE ROBERTS MD” Practice Location

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