Provider Demographics
NPI:1154652741
Name:BRADDY-ROBERTS, JULIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:BRADDY-ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:B
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3890 TAMPA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3677
Mailing Address - Country:US
Mailing Address - Phone:727-781-3150
Mailing Address - Fax:813-635-2636
Practice Address - Street 1:3890 TAMPA RD STE 102
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3677
Practice Address - Country:US
Practice Address - Phone:727-781-3150
Practice Address - Fax:813-635-2636
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104623207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00874198OtherMEDICARE RAILROAD PROVIDER NUMBER
GA003132895AMedicaid
GA52609601001OtherBCBS/GA
FL002584700Medicaid
202I083584OtherMEDICARE
581719867058OtherTRICARE
FLDJ143ZMedicare PIN