Provider Demographics
NPI:1184803496
Name:ELIZABETH S. ROBERSON, M.D., P.A.
Entity type:Organization
Organization Name:ELIZABETH S. ROBERSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH ANN
Authorized Official - Middle Name:SCHOENE
Authorized Official - Last Name:ROBERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-654-0054
Mailing Address - Street 1:4641 GULFSTARR DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-4793
Mailing Address - Country:US
Mailing Address - Phone:850-654-0054
Mailing Address - Fax:
Practice Address - Street 1:4641 GULFSTARR DR
Practice Address - Street 2:SUITE 106
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-4793
Practice Address - Country:US
Practice Address - Phone:850-654-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME885252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6380Medicare PIN