Fredric Burton Roberts, ED D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301002615 Issued in MI

Practice address

1025 Huron Ave
Port Huron, MI 48060-3763

Phone

(810) 984-4550

Fax

(810) 987-3737

NPI assigned

Sep 27, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421366400000",
    "number": "1619963394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 HURON AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603763",
            "telephone_number": "810-984-4550",
            "fax_number": "810-987-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 HURON AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603763",
            "telephone_number": "810-984-4550",
            "fax_number": "810-987-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "FREDRIC",
        "middle_name": "BURTON",
        "name_prefix": "Dr.",
        "credential": "ED D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2015-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301002615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "680G445000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mackenzie Marie Ritchie
• Rite Aid of Michigan Inc
• Riverview Physical Therapy and Rehab,LLC
• Rob Smith
• Eric James Robb, M.D.
• Jeremy Michael Roberts, D.O.
• Quinn Olivia Roberts
• Riley Robinson, PA-C
• Thomas James Robinson
• Robert Roche, PTA

• Psychologist in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.