Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH9526 | FL |
N | 111NR0400X | Rehabilitation Chiropractor | CH9526 | FL |
NPI | 1275703027 |
---|---|
Provider Name | Dr. Edwin Brooks Roberts |
First Address | Pensacola, FL 32507-1268 |
Second Address | Pensacola, FL 32507-1268 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 26/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AQ706Z | MEDICARE PTAN (01) | FL |