Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 04-34426 | KS |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 106994 | MO |
N | 207VG0400X | Gynecologist | 106994 | MO |
NPI | 1609936293 |
---|---|
Provider Name | Christopher H. Roberts |
First Address | Joplin, MO 64804-8435 |
Second Address | Joplin, MO 64804-3015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 04/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G07097 | (02) | MO |