Doctor Name: | DR. JOHN CONRAD ROBERTS |
NPI Number: | 1336585918 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101250843 |
Business Practice Address: | 719 N 25th St Richmond, VA - 232236539 |
Business Phone Number: | 8047800840 |
Business Fax Number: | |
Mailing Address: | 719 N 25th St, RICHMOND |
State: | VA |
Postal Code: | 232236539 |
Phone Number: | 8047800840 |
Fax Number: | |
NPI Enumeration Date: | 05/22/2013 |
NPI Last Update Date: | 05/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101250843 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |