Individual
DR. JONATHAN CHARLES ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
427 W NORTHMOOR RD, PEORIA, IL 61614-3542
(309) 692-5337
(309) 693-3913
Mailing address
427 W NORTHMOOR RD, PEORIA, IL 61614-3542
(309) 692-5337
(309) 693-3913
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
125.054688
IL
208000000X
Pediatrics Physician
55876
WI
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
55876
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871757070
—
WI
Enumeration date
07/16/2008
Last updated
07/30/2021
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