Provider Demographics
NPI:1689670960
Name:ROESER, ROBERT R (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:ROESER
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 1:715 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9056
Mailing Address - Country:US
Mailing Address - Phone:316-283-6655
Mailing Address - Fax:
Practice Address - Street 1:715 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9056
Practice Address - Country:US
Practice Address - Phone:316-283-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207R00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100640640-CMedicaid
KS100640640-CMedicaid
KS111080Medicare ID - Type Unspecified