Healthcare Provider Details

I. General information

NPI: 1124042247
Provider Name (Legal Business Name): JOHN E ROBERTS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 N FEDERAL HWY SUITE ONE
FORT LAUDERDALE FL
33308-2600
US

IV. Provider business mailing address

5700 N FEDERAL HWY SUITE ONE
FORT LAUDERDALE FL
33308-2600
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-6400
  • Fax: 954-771-8835
Mailing address:
  • Phone: 954-491-6400
  • Fax: 954-771-8835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0068639
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: