Provider Demographics
NPI:1942282538
Name:ROBERTS, LON EDWARD JR (MD)
Entity Type:Individual
Prefix:MR
First Name:LON
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 STERLING WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1176
Mailing Address - Country:US
Mailing Address - Phone:859-498-0200
Mailing Address - Fax:859-498-5812
Practice Address - Street 1:100 STERLING WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1176
Practice Address - Country:US
Practice Address - Phone:859-498-0200
Practice Address - Fax:859-498-5812
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2013-05-14
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Provider Licenses
StateLicense IDTaxonomies
KY19053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64190531Medicaid
KY000000229189OtherANTHEM
KY10805823OtherCAQH
D92445Medicare UPIN
KY000000229189OtherANTHEM
KY64190531Medicaid
KY0714501Medicare ID - Type Unspecified