Provider Demographics
NPI:1861832131
Name:ROBERTS, DANIEL BEARSS (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:BEARSS
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 1:10935 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3181
Mailing Address - Country:US
Mailing Address - Phone:317-732-8026
Mailing Address - Fax:317-344-8287
Practice Address - Street 1:10935 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3181
Practice Address - Country:US
Practice Address - Phone:317-732-8026
Practice Address - Fax:317-344-8287
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021562A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC25327Medicare UPIN
INDA530900AMedicare PIN