Healthcare Provider Details

I. General information

NPI: 1700622412
Provider Name (Legal Business Name): PL ROBERTS ID LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

PO BOX 160057
MIAMI FL
33116-0057
US

V. Phone/Fax

Practice location:
  • Phone: 786-358-4443
  • Fax: 786-685-2059
Mailing address:
  • Phone: 786-358-4443
  • Fax: 786-685-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL L. ROBERTS JR.
Title or Position: OWNER/ PRESIDENT
Credential: DO
Phone: 786-358-4443