Active NPI
Earl Judson Roberts, MD
- Pediatrics Physician
- West Palm Beach, FL
National Provider Identifier
1891796264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 18418
- Practice address
- 1401 Forum Way
Suite 300
West Palm Beach, FL 33401 - Phone
- (561) 242-0505
- Fax
- (561) 242-9883
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 18418 | FL | Primary |
Addresses
Primary practice location
1401 Forum Way
Suite 300
West Palm Beach, FL 33401
Mailing address
1401 Forum Way
Suite 300
West Palm Beach, FL 33401
Phone (561) 242-0505
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 054783200 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18418 | FL | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565136000000",
"number": "1891796264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1401 FORUM WAY",
"address_2": "SUITE 300",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33401",
"telephone_number": "561-242-0505",
"fax_number": "561-242-9883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 FORUM WAY",
"address_2": "SUITE 300",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "33401",
"telephone_number": "561-242-0505",
"fax_number": "561-242-9883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "EARL",
"middle_name": "JUDSON",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-09",
"last_updated": "2019-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "18418",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "054783200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Palm Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.