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General NPI Number Information
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NPI Number | 1811183668
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL PRACTICE OF THE TREASURE COAST PA
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 2100 NEBRASKA AVENUE STE 205
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-645-9901
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Fax | 772-465-9870
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Provider Business Mailing Address
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Address Line | PO BOX 12250
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City | FORT PIERCE
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State | FL
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Zip | 34979-2250
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Country | US
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Telephone | 772-645-9901
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Fax | 772-465-9870
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES ALFRED ROBERTS
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Credential | M.D.
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Telephone | 772-468-9901
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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 | ME0034175
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License Number State | FL
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