Provider Demographics
NPI:1770810277
Name:ROBERTS, KEITH EUGENE (LMT, CD(DONA))
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:EUGENE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:LMT, CD(DONA)
Other - Prefix:
Other - First Name:KEITH
Other - Middle Name:EUGENE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KEITH ROBERTS
Mailing Address - Street 1:610 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1743
Mailing Address - Country:US
Mailing Address - Phone:719-632-5912
Mailing Address - Fax:719-632-5912
Practice Address - Street 1:610 PIONEER LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1743
Practice Address - Country:US
Practice Address - Phone:719-632-5912
Practice Address - Fax:719-632-5912
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4900374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula