Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | FLME0083864 | FL |
NPI | 1083666853 |
---|---|
Provider Name | Jay Kirk Roberts |
First Address | Atlanta, GA 30384-7575 |
Second Address | Naples, FL 34119-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 24/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263677800 | (05) | FL |
C64701 | (02) | FL |