Provider Demographics
NPI:1649202565
Name:ROBLES, EDUARDO ALFONSO (DO)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:ALFONSO
Last Name:ROBLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-0188
Mailing Address - Country:US
Mailing Address - Phone:740-773-4366
Mailing Address - Fax:740-775-7855
Practice Address - Street 1:1950 MOUNT SAINT MARYS DR
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1280
Practice Address - Country:US
Practice Address - Phone:740-797-2352
Practice Address - Fax:740-775-9159
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007043R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2184569Medicaid
OHR04030422Medicare ID - Type Unspecified
OH2184569Medicaid