Individual
DR. JEFFREY BENNINGTON ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13540 HULL STREET RD, MIDLOTHIAN, VA 23112-2107
(804) 739-6142
(804) 739-8923
Mailing address
13540 HULL STREET RD, MIDLOTHIAN, VA 23112-2107
(804) 739-6142
(804) 739-8923
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0101248946
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
2007-00785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5909191
—
NC
01
—
C09633
GROUP PTAN
VA
Enumeration date
02/01/2008
Last updated
04/05/2011
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