Provider Demographics
NPI:1669434106
Name:ROBERTS, JUSTIN KURT (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:KURT
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 1:320 ALPENGLOW LN
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-8506
Mailing Address - Country:US
Mailing Address - Phone:406-222-0800
Mailing Address - Fax:406-222-7606
Practice Address - Street 1:320 ALPENGLOW LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-8506
Practice Address - Country:US
Practice Address - Phone:406-222-0800
Practice Address - Fax:406-222-7606
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0244208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170944613Medicaid
TX159582101OtherFIRSTCARE
TX8AN710OtherBCBS
TX159582101OtherFIRSTCARE
TXI20066Medicare UPIN
TX8L26571Medicare PIN