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General NPI Number Information
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NPI Number | 1689767691
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Entity Type | Individual
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Provider Name | MARK A. ROBERTS MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 06/14/2012
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Provider Practice Location Address
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Address Line | 1240 81ST STREET SOUTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33707
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Country | US
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Telephone | 727-345-7434
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Fax | 727-345-7434
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Provider Business Mailing Address
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Address Line | 65 66TH ST N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-8407
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Country | US
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Telephone | 727-343-9100
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Fax | 727-343-9102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME83611
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License Number State | FL
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