Provider Demographics
NPI:1609918200
Name:ROBERTS, JAMES W (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:ROBERTS
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 1:2960 S MCCALL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-7792
Mailing Address - Country:US
Mailing Address - Phone:941-473-3838
Mailing Address - Fax:
Practice Address - Street 1:2960 S MCCALL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-7792
Practice Address - Country:US
Practice Address - Phone:941-473-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME876462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78993AOtherBLUE CROSS BLUE SHIELD
FL78993AOtherBLUE CROSS BLUE SHIELD