Provider Demographics
NPI:1578593620
Name:ROBERTS, PHILIP L (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
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:PO BOX 682985
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-2985
Mailing Address - Country:US
Mailing Address - Phone:615-972-9700
Mailing Address - Fax:615-369-6340
Practice Address - Street 1:529 CAPP HARLAN RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1808
Practice Address - Country:US
Practice Address - Phone:270-487-9231
Practice Address - Fax:270-487-5784
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23857207P00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009977130Medicaid
KY64249790Medicaid
KY000000204367OtherBCBS
TN4029412OtherBCBS
WV1804660000Medicaid
TN3838848Medicaid
TN3072989Medicaid
OH2273070Medicaid
TN3838848Medicaid
OH2273070Medicaid
TN3838849Medicare PIN
KY000000204367OtherBCBS
OHRO4063441Medicare PIN
KY930099029Medicare PIN
KY0931036Medicare PIN
KY1857901Medicare PIN