Individual
MR. THOMAS G ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12671 EMERALD COAST PKWY W, UNIT 215, MIRAMAR BEACH, FL 32550-8300
(850) 424-7170
(850) 424-7169
Mailing address
12671 EMERALD COAST PKWY W UNIT 215, UNIT 215, MIRAMAR BEACH, FL 32550-8304
(850) 424-7170
(850) 424-7169
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 3482
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA0003482
STATE LICENSE NUMBER
FL
Enumeration date
07/25/2006
Last updated
06/15/2011
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