Provider Demographics
NPI:1922197805
Name:ACOSTA, ROBERTO E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:E
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 BUTLER ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6036
Mailing Address - Country:US
Mailing Address - Phone:561-832-0124
Mailing Address - Fax:561-832-3776
Practice Address - Street 1:200 BUTLER ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-6036
Practice Address - Country:US
Practice Address - Phone:561-832-0124
Practice Address - Fax:561-832-3776
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL16702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55386Medicare UPIN