Individual
DR. JONATHAN M. 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) 556-7722
(573) 635-1527
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 556-7722
(573) 635-1527
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
106956
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020025136
MEDICARE RAILROAD
MO
05
—
207779802
—
MO
01
—
CD6061
RR GROUP
MO
Enumeration date
12/20/2005
Last updated
08/07/2008
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