Provider Demographics
NPI:1386648376
Name:ROBERTS, EDWIN P (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:P
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4469 MOBILE HWY
Mailing Address - Street 2:STE D
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-7100
Mailing Address - Country:US
Mailing Address - Phone:850-912-4155
Mailing Address - Fax:
Practice Address - Street 1:4469 MOBILE HWY STE D
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-7100
Practice Address - Country:US
Practice Address - Phone:850-912-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70309OtherBLUE SHIELD OF FLORIDA
FL050443200Medicaid
FL350019604OtherRAILROAD MEDICARE
FL70309ZOtherMEDICARE PTAN
FL5609005OtherAETNA INSURANCE
FL70309OtherBLUE SHIELD OF FLORIDA
FL350019604OtherRAILROAD MEDICARE