Healthcare Provider Details

I. General information

NPI: 1164485611
Provider Name (Legal Business Name): ROBERT J HOVER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 4TH ST N
ST PETERSBURG FL
33702-3604
US

IV. Provider business mailing address

8100 4TH ST N
ST PETERSBURG FL
33702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 727-577-6929
  • Fax: 727-577-5829
Mailing address:
  • Phone: 727-577-6929
  • Fax: 727-577-5829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS2792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: