Provider Demographics
NPI:1831366681
Name:ROBERTS, JOSHUA C (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:C
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:787 37TH ST
Mailing Address - Street 2:STE E220
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7305
Mailing Address - Country:US
Mailing Address - Phone:772-770-9127
Mailing Address - Fax:772-770-1530
Practice Address - Street 1:787 37TH ST
Practice Address - Street 2:STE E220
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7305
Practice Address - Country:US
Practice Address - Phone:772-770-9127
Practice Address - Fax:772-770-1530
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3362213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017739700Medicaid
FL017739700Medicaid
FLP01501783Medicare PIN