Provider Demographics
NPI:1326018771
Name:ROBERTS, DUSTIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 THELMA DR
Mailing Address - Street 2:PMB 155
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-2325
Mailing Address - Country:US
Mailing Address - Phone:307-577-2073
Mailing Address - Fax:
Practice Address - Street 1:1233 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2926
Practice Address - Country:US
Practice Address - Phone:307-577-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01091089A207L00000X
WY10068A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology