Healthcare Provider Details

I. General information

NPI: 1528037967
Provider Name (Legal Business Name): ROBERT A ROMBOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CYPRESS POINT PKWY
PALM COAST FL
32164-2500
US

IV. Provider business mailing address

15 AVENUE DE LA MER UNIT 2105
PALM COAST FL
32137-2285
US

V. Phone/Fax

Practice location:
  • Phone: 863-412-3073
  • Fax:
Mailing address:
  • Phone: 863-412-3073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME42497
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: