Healthcare Provider Details

I. General information

NPI: 1699748251
Provider Name (Legal Business Name): ROBERT M MAYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CLEARWATER LARGO RD N
LARGO FL
33770-4131
US

IV. Provider business mailing address

1100 CLEARWATER LARGO RD N
LARGO FL
33770-4131
US

V. Phone/Fax

Practice location:
  • Phone: 727-518-6444
  • Fax: 727-581-2678
Mailing address:
  • Phone: 727-518-6444
  • Fax: 727-581-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME48573
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME48573
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier48815100
Identifier TypeMEDICAID
Identifier StateFL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: