Individual
KENNETH C ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 VETERANS, BILOXY, MS 39531
(228) 523-4555
Mailing address
PO BOX 850299, YUKON, OK 73085-0299
(985) 966-3757
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
021531
LA
207R00000X
Internal Medicine Physician
Primary
18538
MS
207R00000X
Internal Medicine Physician
2974
OK
Other
Enumeration date
11/21/2006
Last updated
07/08/2007
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