Provider Demographics
NPI:1750344594
Name:ROBERTS, JOEL FRED (DO)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:FRED
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-581-4849
Mailing Address - Fax:727-584-7429
Practice Address - Street 1:2 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3201
Practice Address - Country:US
Practice Address - Phone:727-446-4461
Practice Address - Fax:727-441-4107
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-08-25
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Provider Licenses
StateLicense IDTaxonomies
FLOS5636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044489800Medicaid
FL80185OtherBLUE CROSS BLUE SHIELD
FL044489800Medicaid
FL80185XMedicare PIN