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NPI Code Detail

MEDICARE: ROBERT STEPHEN KANNER MD

MEDICARE: ROBERT STEPHEN KANNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology PhysicianME29405FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2100003106OTHERFLMEDICARE, RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053313700
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT STEPHEN KANNER MD
Provider Business Mailing Address
First Line : 4800 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6004
Country : US
Telephone Number : 904-398-7205
Fax Number : 904-396-4047
Provider Business Practice Location Address
First Line : 4800 BELFORT RD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32256-6004
Country : US
Telephone Number : 904-398-7205
Fax Number : 904-396-4047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2005
Last Update Date : 05/24/2011

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Directions to “ ROBERT STEPHEN KANNER MD” Practice Location

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