Healthcare Provider Details

I. General information

NPI: 1154766541
Provider Name (Legal Business Name): PAUL ROBERTS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8529 SOUTHPARK CIR SUITE 270
ORLANDO FL
32819-9029
US

IV. Provider business mailing address

8529 SOUTHPARK CIR SUITE 270
ORLANDO FL
32819-9029
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-7080
  • Fax:
Mailing address:
  • Phone: 407-351-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberOS5120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: