Healthcare Provider Details

I. General information

NPI: 1962573295
Provider Name (Legal Business Name): VERA M ROBERT MD DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12565 COLLIER BLVD
NAPLES FL
34116-5243
US

IV. Provider business mailing address

2110 19TH ST SW
NAPLES FL
34117-4724
US

V. Phone/Fax

Practice location:
  • Phone: 239-455-9919
  • Fax: 239-455-9906
Mailing address:
  • Phone: 239-353-1015
  • Fax: 239-455-9906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VERA M ROBERT
Title or Position: OWNER PHYSICIAN
Credential: DO
Phone: 239-455-9919