MEDICARE: DR. THOMAS WHITFIELD ROBERTS DPM

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	213E00000X	Podiatrist	PO 3084	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65817Z	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1841221181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS WHITFIELD ROBERTS DPM

Provider Business Mailing Address
First Line	:	2441 US HIGHWAY 98 W STE 102
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5386
Country	:	US
Telephone Number	:	850-650-6492
Fax Number	:	850-650-2178

Provider Business Practice Location Address
First Line	:	2441 US HIGHWAY 98 W STE 102
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5386
Country	:	US
Telephone Number	:	850-650-6492
Fax Number	:	850-650-2178

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/05/2019

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