Provider Demographics
NPI:1457300881
Name:ROBERTS, JOHN MILTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MILTON
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BEAMAN ST
Mailing Address - Street 2:SUITE 50L
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2650
Mailing Address - Country:US
Mailing Address - Phone:910-590-8000
Mailing Address - Fax:910-590-8002
Practice Address - Street 1:603 BEAMAN ST
Practice Address - Street 2:SUITE 50L
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2650
Practice Address - Country:US
Practice Address - Phone:910-590-8000
Practice Address - Fax:910-590-8002
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC72188OtherBCBS
NC8972188Medicaid
NC209955AMedicare ID - Type Unspecified
NC72188OtherBCBS