MEDICARE: FAMILY MEDICAL PRACTICE OF THE TREASURE COAST PA

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	ME0034175	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	95303	OTHER	FL	BCBS FL

General Provider Information

NPI Number	:	1811183668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL PRACTICE OF THE TREASURE COAST PA

Provider Business Mailing Address
First Line	:	PO BOX 12250
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34979-2250
Country	:	US
Telephone Number	:	772-645-9901
Fax Number	:	772-465-9870

Provider Business Practice Location Address
First Line	:	2100 NEBRASKA AVENUE
Second Line	:	STE 205
City	:	FORT PIERCE
State	:	FL
Zip	:	34950
Country	:	US
Telephone Number	:	772-645-9901
Fax Number	:	772-465-9870

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES ALFRED ROBERTS
Credential	:	M.D.
Telephone Number	:	772-468-9901

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	05/25/2018

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