Healthcare Provider Details

I. General information

NPI: 1518951441
Provider Name (Legal Business Name): ROBERT J CATALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR STE 515 CREDENTIALING DEPARTMENT
JACKSONVILLE FL
32207-8207
US

IV. Provider business mailing address

PO BOX 44004
JACKSONVILLE FL
32231-4004
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-4886
  • Fax: 904-398-0496
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-398-0496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME80402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: