Provider Demographics
NPI:1477548378
Name:ROBERTS, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
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 1:2160 COLONIAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1 HOSPITAL DRIVE SUITE 102
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4565
Practice Address - Country:US
Practice Address - Phone:828-225-1915
Practice Address - Fax:828-252-5180
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99003342085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00046512OtherRAILROAD MCARE PROVIDER #
NC891191NMedicaid
NC4567509OtherAETNA PROVIDER #
NC1191NOtherBCBS OF NC PROVIDER #
NCA4056OtherMEDCOST PROVIDER #
FL1168747OtherGATEWAY HEALTH
NC1424836010OtherCIGNA PROVIDER #
NC891191NMedicaid
NC1191NOtherBCBS OF NC PROVIDER #