Provider Demographics
NPI:1790767457
Name:ESPER, ROBERT J (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ESPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:J
Other - Last Name:ESPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:814-868-2507
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:2820 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4204
Practice Address - Country:US
Practice Address - Phone:814-833-8800
Practice Address - Fax:814-833-2079
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003983L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006792460001Medicaid
PA0006792460001Medicaid
016961Medicare ID - Type Unspecified