Provider Demographics
NPI:1184787236
Name:ROBERTS, CAROL LEE (MD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 MAYS AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-4427
Mailing Address - Country:US
Mailing Address - Phone:813-417-7010
Mailing Address - Fax:813-671-3262
Practice Address - Street 1:800 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5400
Practice Address - Country:US
Practice Address - Phone:239-649-7400
Practice Address - Fax:239-649-6370
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1184787236OtherNPI
FLD67281Medicare UPIN
FL79360Medicare ID - Type Unspecified