MEDICARE: DR. JULIE BRADDY-ROBERTS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME104623	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00874198	OTHER	FL	MEDICARE RAILROAD PROVIDER NUMBER
5	202I083584	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	52609601001	OTHER	GA	BCBS/GA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	581719867058	OTHER		TRICARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154652741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE BRADDY-ROBERTS MD

Provider Business Mailing Address
First Line	:	2995 DREW ST FL 2
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-532-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	3890 TAMPA RD STE 102
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3677
Country	:	US
Telephone Number	:	727-781-3150
Fax Number	:	813-635-2636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2010
Last Update Date	:	02/20/2026

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Directions to “ DR. JULIE BRADDY-ROBERTS MD” Practice Location

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