Provider Demographics
NPI:1629331004
Name:BISHOP, NATALIE VICTORIA ROEBUCK (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:VICTORIA ROEBUCK
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:VICTORIA
Other - Last Name:ROEBUCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 S ANDREWS AVE FL PICU7
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2510
Mailing Address - Country:US
Mailing Address - Phone:954-468-8000
Mailing Address - Fax:954-468-8007
Practice Address - Street 1:1600 S ANDREWS AVE FL PICU7
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-468-8000
Practice Address - Fax:954-468-8007
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03613894052080P0203X
FL1461042080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine