Provider Demographics
NPI:1518968619
Name:ROBER, PAUL EWALD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EWALD
Last Name:ROBER
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:211 FOUNTAIN CT STE 230
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2696
Practice Address - Country:US
Practice Address - Phone:859-929-7200
Practice Address - Fax:859-629-7212
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-07-11
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
IN01041942208800000X
KY47817208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100377700AMedicaid
KY7100355520Medicaid
INF77568Medicare UPIN
KY7100355520Medicaid