Provider Demographics
NPI:1336134592
Name:GEOFFREY ROBERTS, D.O.,P.A.
Entity Type:Organization
Organization Name:GEOFFREY ROBERTS, D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-795-5544
Mailing Address - Street 1:756 N SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-9072
Mailing Address - Country:US
Mailing Address - Phone:352-795-5544
Mailing Address - Fax:
Practice Address - Street 1:756 N SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-9072
Practice Address - Country:US
Practice Address - Phone:352-795-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660031000Medicaid
FL82659OtherBCBS
FLK0670OtherMEDICARE PART B TRADITION
FL82659OtherBCBS
FLK0670OtherMEDICARE PART B TRADITION