Healthcare Provider Details

I. General information

NPI: 1336161892
Provider Name (Legal Business Name): ROBERT THOMAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5731 BEE RIDGE RD
SARASOTA FL
34233-5056
US

IV. Provider business mailing address

PO BOX 860554
ORLANDO FL
32886-0554
US

V. Phone/Fax

Practice location:
  • Phone: 941-342-1100
  • Fax:
Mailing address:
  • Phone: 904-346-3606
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS0008592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: