Provider Demographics
NPI:1659360311
Name:AUDET, ROBERT JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOSEPH
Last Name:AUDET
Suffix:JR
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 39
Mailing Address - Street 2:
Mailing Address - City:WEYERS CAVE
Mailing Address - State:VA
Mailing Address - Zip Code:24486-0039
Mailing Address - Country:US
Mailing Address - Phone:540-234-0080
Mailing Address - Fax:540-234-8688
Practice Address - Street 1:54 FRANKLIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-2340
Practice Address - Country:US
Practice Address - Phone:540-234-0080
Practice Address - Fax:540-234-8688
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231993208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541945667001OtherTRICARE
VA2245111000OtherDOL
VA10696714OtherVALLEY HEALTH PLAN
VA462584OtherANTHEM
VA0152971OtherCIGNA
VA207918OtherSOUTHERN HEALTH
VA462584OtherANTHEM BC/BS
VA462584OtherANTHEM
VA10696714OtherVALLEY HEALTH PLAN
VAP00012509Medicare ID - Type UnspecifiedRAILROAD MEDICARE