Basic Information
| Provider Information | |||||||||
| NPI: | 1033630124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROXBOROUGH | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 MOUNTCASTLE RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627041597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022076929 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4414 BENNING RD NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200194555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023887891 | ||||||||
| FaxNumber: | 2025488600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125.070326 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | D0089405 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD048736 | DC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.