Provider Demographics
NPI:1841221181
Name:ROBERTS, THOMAS WHITFIELD (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WHITFIELD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 US HIGHWAY 98 W STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-5386
Mailing Address - Country:US
Mailing Address - Phone:850-650-6492
Mailing Address - Fax:850-650-2178
Practice Address - Street 1:2441 US HIGHWAY 98 W STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-5386
Practice Address - Country:US
Practice Address - Phone:850-650-6492
Practice Address - Fax:850-650-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3084213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65817ZOtherMEDICARE
FL65817AMedicare ID - Type Unspecified
FLV00415Medicare UPIN