Provider Demographics
NPI:1194880658
Name:CHERYL J ROBERTS MD, PA
Entity type:Organization
Organization Name:CHERYL J ROBERTS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-546-7837
Mailing Address - Street 1:100 ESTRADA SQ
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-2400
Mailing Address - Country:US
Mailing Address - Phone:772-546-3751
Mailing Address - Fax:772-546-7941
Practice Address - Street 1:100 ESTRADA SQ
Practice Address - Street 2:
Practice Address - City:HOBE SOUND
Practice Address - State:FL
Practice Address - Zip Code:33455-2400
Practice Address - Country:US
Practice Address - Phone:772-546-3751
Practice Address - Fax:772-546-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE90620Medicare UPIN
FLK5265Medicare ID - Type Unspecified