Provider Demographics
NPI:1497748123
Name:ROBERSON, CLIVE E (MD)
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:E
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N FLAGLER DR STE 3000
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3425
Mailing Address - Country:US
Mailing Address - Phone:561-655-4450
Mailing Address - Fax:561-655-4469
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE #6100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-655-4450
Practice Address - Fax:561-655-4469
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME9904207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044509600Medicaid
FL50429EMedicare ID - Type Unspecified
FL044509600Medicaid