Basic Information
| Provider Information | |||||||||
| NPI: | 1023064771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | NO 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 E HAMPDEN AVE | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801132702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 3037616322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 09/18/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 14836 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 117318900 | 01 | WY | WY MEDICAID | OTHER | 300049138 | 01 | CO | RR MIC MCRE | OTHER | 02721906 | 01 | NY | NY MEDICAID | OTHER | 01148360 | 05 | CO | MEDICAID | 200424870A | 01 | KS | KS MEDICAID | OTHER | XPY204517 | 01 | CA | CA MEDICAID | OTHER | 104693092 | 01 | MI | MI MEDICAID | OTHER | 053209501 | 01 | TX | TX MEDICAID | OTHER | 84-059792913 | 05 | NE | MEDICAID | 300090359 | 01 | CO | RR DIA MCRE | OTHER | 300061205 | 01 | CO | RR RIA MCRE | OTHER |