Individual
MR. SANDY TALMADGE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22909 E STATE ROUTE 58, PLEASANT HILL, MO 64080-8542
(816) 348-1000
Mailing address
22909 E STATE ROUTE 58, PLEASANT HILL, MO 64080-8542
(816) 540-6140
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
171M00000X
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003953647
64012
MO
Enumeration date
03/07/2007
Last updated
07/08/2007
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