Healthcare Provider Details

I. General information

NPI: 1104357946
Provider Name (Legal Business Name): PAUL ROBERTS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 68TH ST SUITE 202
HIALEAH FL
33016-1801
US

IV. Provider business mailing address

PO BOX 160057
MIAMI FL
33116-0057
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-2107
  • Fax:
Mailing address:
  • Phone: 786-358-4443
  • Fax: 786-685-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberOS16413
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS16413
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: