Organization
VAIN CLINIC ,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA ROBERTS M.D. (OWNER PHYSICIAN)
(772) 871-8922
Entity
Organization
Contact information
Practice address
1599 SE LENNARD RD, PORT ST LUCIE, FL 34952-6542
(772) 871-8922
(772) 871-8928
Mailing address
1599 SE LENNARD RD, PORT ST LUCIE, FL 34952-6542
(772) 871-8922
(772) 871-8928
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
ME63493
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME63493
MEDICAL LICENSE
FL
Enumeration date
04/17/2007
Last updated
05/10/2016
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