Provider Demographics
NPI:1346226404
Name:DRS ROBERTS & BRYAN PA
Entity type:Organization
Organization Name:DRS ROBERTS & BRYAN PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-301-4747
Mailing Address - Street 1:1286 FLORIDA AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2484
Mailing Address - Country:US
Mailing Address - Phone:321-636-7780
Mailing Address - Fax:321-636-1152
Practice Address - Street 1:1286 FLORIDA AVE S
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2484
Practice Address - Country:US
Practice Address - Phone:321-636-7780
Practice Address - Fax:321-636-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC11086OtherRR MEDICARE
FL063028400Medicaid
FL063028400Medicaid