Provider Demographics
NPI:1144345695
Name:ROBLES, MANUEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:ANTONIO
Last Name:ROBLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 NW 101ST DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6605
Mailing Address - Country:US
Mailing Address - Phone:954-803-4440
Mailing Address - Fax:954-753-8309
Practice Address - Street 1:4331 NW 101ST DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-6605
Practice Address - Country:US
Practice Address - Phone:954-803-4440
Practice Address - Fax:954-753-8309
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44076207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254294300Medicaid
FL254294300Medicaid
FLD63193Medicare UPIN