Doctor Name: | MR. THOMAS G ROBERTS |
NPI Number: | 1205859857 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA 3482 |
Business Practice Address: | 12671 Emerald Coast Pkwy W Unit 215 Miramar Beach, FL - 325508300 |
Business Phone Number: | 8504247170 |
Business Fax Number: | 8504247169 |
Mailing Address: | 12671 Emerald Coast Pkwy W Unit 215, Unit 215 MIRAMAR BEACH |
State: | FL |
Postal Code: | 325508304 |
Phone Number: | 8504247170 |
Fax Number: | 8504247169 |
NPI Enumeration Date: | 07/25/2006 |
NPI Last Update Date: | 06/15/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA 3482 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |