Provider Demographics
NPI:1023270733
Name:ROBERTS, JOHN MOSE JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MOSE
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9320 GRAND CORDERAL PARKWAY
Mailing Address - Street 2:SUITE 255
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7021
Mailing Address - Country:US
Mailing Address - Phone:719-258-1240
Mailing Address - Fax:719-282-1247
Practice Address - Street 1:9320 GRAND CORDERA PARKWAY
Practice Address - Street 2:SUITE 255
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7021
Practice Address - Country:US
Practice Address - Phone:719-258-1240
Practice Address - Fax:719-282-1247
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2016-03-21
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Provider Licenses
StateLicense IDTaxonomies
CODR.0054821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56571747Medicaid
CO56571747Medicaid