Healthcare Provider Details

I. General information

NPI: 1942282413
Provider Name (Legal Business Name): MALCOLM DUNCAN ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MERCY DR
ORLANDO FL
32808-5646
US

IV. Provider business mailing address

200 AVENUE F NE
WINTER HAVEN FL
33881-4131
US

V. Phone/Fax

Practice location:
  • Phone: 407-875-3700
  • Fax: 407-822-5024
Mailing address:
  • Phone: 863-293-1121
  • Fax: 863-294-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME59313
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME59313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: