Provider Demographics
NPI:1558527903
Name:ROYALTY, ROBERT NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:NATHAN
Last Name:ROYALTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-0406
Mailing Address - Country:US
Mailing Address - Phone:606-889-6255
Mailing Address - Fax:606-889-6256
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:SUITE 4139
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-889-6255
Practice Address - Fax:606-889-6256
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY44218207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100113730Medicaid
KYK007301Medicare PIN