Individual
DR. LAYNE D. ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2000 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3138
(208) 587-1500
(208) 587-3180
Mailing address
2000 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3138
(208) 587-1500
(208) 587-3180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-91
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010002108
BLUE SHIELD OF IDAHO
ID
05
—
003897000
—
ID
01
—
080177677
RAIL ROAD MEDICARE
ID
01
—
S3374
BLUE CROSS OF IDAHO
ID
Enumeration date
05/31/2005
Last updated
09/27/2012
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