Healthcare Provider Details

I. General information

NPI: 1568490407
Provider Name (Legal Business Name): JAMES A. ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-3120
US

IV. Provider business mailing address

1301 2ND AVE SW
LARGO FL
33770-3120
US

V. Phone/Fax

Practice location:
  • Phone: 727-584-7706
  • Fax: 727-581-4822
Mailing address:
  • Phone: 727-584-7706
  • Fax: 727-581-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME53252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: