Provider Demographics
NPI:1891725206
Name:ROBERTS, VICTOR L (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:L
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 1:766 N. SUN DRIVE
Mailing Address - Street 2:SUITE 2060
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:407-936-3860
Mailing Address - Fax:407-936-3866
Practice Address - Street 1:766 N. SUN DRIVE
Practice Address - Street 2:SUITE 2060
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-936-3860
Practice Address - Fax:407-936-3866
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0042333207RE0101X
FLME42333207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106264000Medicaid
FLA29780Medicare UPIN