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General NPI Number Information
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NPI Number | 1700622412
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Entity Type | Organization
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Legal Business Name | PL ROBERTS ID LLC
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Dates
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Enumeration Date | 07/02/2024
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 2001 W 68TH ST
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City | HIALEAH
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State | FL
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Zip | 33016-1801
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Country | US
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Telephone | 786-358-4443
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Fax | 786-685-2059
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Provider Business Mailing Address
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Address Line | PO BOX 160057
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City | MIAMI
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State | FL
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Zip | 33116-0057
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Country | US
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Telephone | 786-358-4443
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Fax | 786-685-2059
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. PAUL L. ROBERTS JR.
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Credential | DO
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Telephone | 786-358-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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