Individual
GREGORY L ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
219 GRANT UTELY AVE NW, CASS LAKE, MN 56633
(218) 335-2559
Mailing address
219 GRANT UTELY AVE NW, PO BOX 67, CASS LAKE, MN 56633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
30341
CO
207Q00000X
Family Medicine Physician
Primary
36046
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01303411
—
CO
01
—
080060522
RAIL ROAD MEDICARE
CO
Enumeration date
07/10/2006
Last updated
04/29/2022
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