Provider Demographics
NPI:1356346936
Name:ROBERTS, JAMES GREGORY (MD, RVT FACS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:ROBERTS
Suffix:
Gender:
Credentials:MD, RVT FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 15TH ST. STE 220
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631
Mailing Address - Country:US
Mailing Address - Phone:970-810-5462
Mailing Address - Fax:
Practice Address - Street 1:1541 FLORIDA AVE STE 305
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4439
Practice Address - Country:US
Practice Address - Phone:209-575-5833
Practice Address - Fax:209-575-5836
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60422790208600000X, 2086S0129X
AZ611782086S0129X
IDMC-04542086S0129X
COCDR.00013392086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ091474Medicaid
TN4069830OtherBLUE CROSS BLUE SHIELD
AZ61178OtherAZ LICENSE
TN061707311Medicaid
TN1212093OtherCHA HEALTH
TNTN0101OtherJOHN DEERE HEALTH
WA325383OtherSTATE L&I
TN4069830OtherBLUE CROSS BLUE SHIELD