Individual
DR. E. DWAIN ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 556-7755
(573) 761-3599
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-7755
(573) 761-3599
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
114884
MO
2085R0202X
Diagnostic Radiology Physician
Primary
114884
MO
2085U0001X
Diagnostic Ultrasound Physician
114884
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209786607
—
MO
01
—
300090314
RAILROAD MEDICARE
MO
01
—
CC7852
RR GROUP
MO
01
—
DB1586
GROUP RR
MO
01
—
P00201659
IND. RR
MO
Enumeration date
01/19/2006
Last updated
08/10/2023
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