Provider Demographics
NPI:1669880894
Name:KONIGSBERG, ROBERT (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KONIGSBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 EVERGREEN FARMS LN
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-3432
Mailing Address - Country:US
Mailing Address - Phone:303-697-1176
Mailing Address - Fax:
Practice Address - Street 1:5425 EVERGREEN FARMS LN
Practice Address - Street 2:
Practice Address - City:GREENBACK
Practice Address - State:TN
Practice Address - Zip Code:37742-3432
Practice Address - Country:US
Practice Address - Phone:303-697-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology