Healthcare Provider Details

I. General information

NPI: 1750794616
Provider Name (Legal Business Name): ROBERT KAWA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 SUMMERLIN LN STE 107
ST AUGUSTINE FL
32095-8160
US

IV. Provider business mailing address

206 HORSETAIL CT
ST AUGUSTINE FL
32095-7609
US

V. Phone/Fax

Practice location:
  • Phone: 904-217-0280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: