Provider Demographics
NPI:1164526349
Name:ROOF, ROBERT ANSLEY III (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANSLEY
Last Name:ROOF
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20706 247TH ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:IA
Mailing Address - Zip Code:52223-8416
Mailing Address - Country:US
Mailing Address - Phone:563-927-5529
Mailing Address - Fax:
Practice Address - Street 1:3421 WEST 9TH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702
Practice Address - Country:US
Practice Address - Phone:800-458-5003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02246207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1164526349Medicaid
IA1164526349OtherBLUE SHIELD
IA1164526349OtherBLUE SHIELD