JOHN R ROBERTS, MD - NPI NUMBER 1962441915

Summary

Provider Name: JOHN R ROBERTS, MD

NPI Number: 1962441915

Clasification: Family Medicine (207Q00000X)

Organization: FRANCISCAN PHYSICIAN NETWORK

Address:
308 W MARKET ST
CRAWFORDSVILLE, IN
ZIP 47933

Phone Number: (765) 362-5789



Detailed Information

John R Roberts, MD is a family physician in Crawfordsville, IN with 27 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1962441915 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: INDIANA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1987

The provider's business address is:

308 W MARKET ST
CRAWFORDSVILLE, IN
ZIP 47933
Phone: (765) 362-5789
Fax: (765) 362-2453

The enumeration date for this NPI number is 6/5/2006 and was last updated on 6/13/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207Q00000X Family Medicine 01036855 IN Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 168870 MEDICARE ID-TYPE UNSPECIFIED
2 M400075750 OTHER IN MEDICARE PROVIDER PTAN
3 E06490 MEDICARE UPIN
4 100324060 MEDICAID IN

NPI Record

No. Field Name Field Value
1 NPI 1962441915
2 Entity Type Code 1
3 Provider Last Name Legal Name ROBERTS
4 Provider First Name JOHN
5 Provider Middle Name R
6 Provider Credential Text MD
7 Provider First Line Business Practice Location Address 308 W MARKET ST
8 Provider Business Practice Location Address City Name CRAWFORDSVILLE
9 Provider Business Practice Location Address State Name IN
10 Provider Business Practice Location Address Postal Code 47933
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 7653625789
13 Provider Business Practice Location Address Fax Number 7653622453
14 Provider Enumeration Date 6/5/2006
15 Last Update Date 6/13/2014
16 Provider Gender Code M
17 Healthcare Provider Taxonomy Code 1 207Q00000X
18 Provider License Number 1 01036855
19 Provider License Number State Code 1 IN
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 168870
22 Other Provider Identifier Type Code 1 04
23 Other Provider Identifier 2 M400075750
24 Other Provider Identifier Type Code 2 01
25 Other Provider Identifier State 2 IN
26 Other Provider Identifier Issuer 2 MEDICARE PROVIDER PTAN
27 Other Provider Identifier 3 E06490
28 Other Provider Identifier Type Code 3 02
29 Other Provider Identifier 4 100324060
30 Other Provider Identifier Type Code 4 05
31 Other Provider Identifier State 4 IN
32 Is Sole Proprietor N

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.