Roberts, Jonathan Charles

Roberts, Jonathan Charles is an individual health care provider with primary practice located at 427 W Northmoor Rd , Peoria IL 61614-3542. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Roberts, Jonathan Charles can be contacted via phone (309) 692-5337.

Contact Information

Primary practice address
427 W Northmoor Rd Peoria IL 61614-3542
Phone: (309) 692-5337
Fax: (309) 693-3913
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 55876 Wisconsin
Allopathic & Osteopathic Physicians / Pediatric Emergency Medicine 2080P0204X 55876 Wisconsin
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 125.054688 Illinois

Profile Details

NPI number 1871757070
LBN Legal business name Roberts, Jonathan Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 16th, 2008
Last updated Jul 30th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871757070 NPPES
Wisconsin MEDICAID 1871757070

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