Provider Demographics
NPI:1013278506
Name:ROBERTS, FRED FLETCHER (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:FLETCHER
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 1:5610 W 131ST TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2925
Mailing Address - Country:US
Mailing Address - Phone:913-402-9813
Mailing Address - Fax:
Practice Address - Street 1:5610 W 131ST TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2925
Practice Address - Country:US
Practice Address - Phone:913-402-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7219208000000X, 2085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology