MEDICARE: ROBERT V MCJENNETT DO

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
1	207P00000X	Emergency Medicine Physician	OS8604	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51978	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922001742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT V MCJENNETT DO

Provider Business Mailing Address
First Line	:	4651 1ST ST NE APT 201
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-4940
Country	:	US
Telephone Number	:	727-641-3845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 7TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-1300
Country	:	US
Telephone Number	:	727-825-1491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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