Provider Demographics
NPI:1962630004
Name:ROBERTS, ERIC JUSTIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JUSTIN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2191 9TH AVE N # 150
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-7146
Mailing Address - Country:US
Mailing Address - Phone:727-954-5525
Mailing Address - Fax:888-229-0143
Practice Address - Street 1:2026 5TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8078
Practice Address - Country:US
Practice Address - Phone:727-954-5525
Practice Address - Fax:888-229-0143
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-28
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP77589213ES0103X
FLPO3551213ES0103X
PASC006136213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery