Robert J Petrokubi, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

30771 Issued in KY

Practice address

12500 Mayo CT
Prospect, KY 40059-9159

Phone

(502) 228-2793

Fax

(502) 228-2793

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396915200000",
    "number": "1669428439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12500 MAYO CT",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599159",
            "telephone_number": "502-228-2793",
            "fax_number": "502-228-2793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12500 MAYO CT",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400599159",
            "telephone_number": "502-228-2793",
            "fax_number": "502-228-2793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROKUBI",
        "first_name": "ROBERT",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2014-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "KY",
            "license": "30771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64307713",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Bernheim Penner, M.D.
• Michaela Perry, PHARMD
• Emily Peters, MS., OTR/L
• Mary Love Peters, M.,S., CCC-SLP
• Janis Kaitlin Peterson, DPT
• Kristen Marie Plappert
• Alexa Rae Polston, PHARMD
• Samaneh Pournaghi, DMD
• Phyllis Levon Powell
• Powerback Rehabilitation LLC

• Gastroenterology Physician in Prospect, KY
• Providers in Prospect, KY by specialty
• Gastroenterology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.