Provider Demographics
NPI:1841226479
Name:ROBERTIE, PAUL G (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:ROBERTIE
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 1:150 SE 17TH ST STE 503
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5176
Mailing Address - Country:US
Mailing Address - Phone:352-867-8311
Mailing Address - Fax:352-622-5771
Practice Address - Street 1:1500 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6504
Practice Address - Country:US
Practice Address - Phone:352-867-8311
Practice Address - Fax:352-867-1053
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60116207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059313300Medicaid
FL12464OtherBCBS FL
FL050065894Medicare PIN
FL059313300Medicaid
FLP00403066Medicare PIN
FL12464QMedicare PIN
FL12464OtherBCBS FL
FL050065892Medicare PIN
FLE36061Medicare UPIN
FL12464WMedicare PIN
FL12464XMedicare PIN
FL12464RMedicare PIN