Healthcare Provider Details

I. General information

NPI: 1891796264
Provider Name (Legal Business Name): EARL JUDSON ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FORUM WAY SUITE 300
WEST PALM BEACH FL
33401
US

IV. Provider business mailing address

1401 FORUM WAY SUITE 300
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 561-242-0505
  • Fax: 561-242-9883
Mailing address:
  • Phone: 561-242-0505
  • Fax: 561-242-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: