Provider Demographics
NPI:1235117698
Name:JAIN-ROBERTS, SANGEETA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANGEETA
Middle Name:
Last Name:JAIN-ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SANGEETA
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1619 PADDLEWHEEL CIR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1293
Mailing Address - Country:US
Mailing Address - Phone:573-761-0777
Mailing Address - Fax:
Practice Address - Street 1:1619 PADDLEWHEEL CIR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1293
Practice Address - Country:US
Practice Address - Phone:573-761-0777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCC7852OtherRR GROUP
MO12924OtherBCBS
MO110104028OtherRAILROAD MEDICARE
MO207818303Medicaid
MOCC7852OtherRR GROUP
MO002013715Medicare PIN
MO110104028OtherRAILROAD MEDICARE