Provider Demographics
NPI:1699919829
Name:ROBERTS, JOSHUA LUKE (IDMT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:LUKE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MARBLE APEX AVE
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-6898
Mailing Address - Country:US
Mailing Address - Phone:847-769-9579
Mailing Address - Fax:
Practice Address - Street 1:29 MARBLE APEX AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6898
Practice Address - Country:US
Practice Address - Phone:847-769-9579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians