Healthcare Provider Details

I. General information

NPI: 1467449017
Provider Name (Legal Business Name): ROBERT J SUBBIONDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 61ST ST W
BRADENTON FL
34209-5528
US

IV. Provider business mailing address

6001 21ST AVE W
BRADENTON FL
34209-7847
US

V. Phone/Fax

Practice location:
  • Phone: 941-761-4448
  • Fax: 941-761-0235
Mailing address:
  • Phone: 941-761-4448
  • Fax: 941-761-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME41101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: