Individual
DR. ROGER ROBERTS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01040512A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000112502
ANTHEM PIN #
IN
05
—
200002460
—
IN
01
—
200311740E
MEDICAID GROUP #
IN
01
—
370018016
MEDICARE RAILROAD #
IN
01
—
4561963
AETNA PIN #
IN
Enumeration date
08/15/2005
Last updated
10/11/2010
Update your record
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