Provider Demographics
NPI:1972702744
Name:ROBERTS, JEAN LANGLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:LANGLEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3863
Mailing Address - Country:US
Mailing Address - Phone:765-216-7345
Mailing Address - Fax:765-216-7379
Practice Address - Street 1:1200 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4988
Practice Address - Country:US
Practice Address - Phone:765-282-8991
Practice Address - Fax:765-284-7813
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11013788A207Q00000X
IN01067670A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200995060Medicaid
INP00874039OtherRR MEDICARE
IN000001074965OtherANTHEM
IN200995060Medicaid
INP00874039OtherRR MEDICARE