Healthcare Provider Details

I. General information

NPI: 1922001742
Provider Name (Legal Business Name): ROBERT V MCJENNETT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 7TH AVE N
ST PETERSBURG FL
33705-1300
US

IV. Provider business mailing address

4651 1ST ST NE APT 201
ST PETERSBURG FL
33703-4940
US

V. Phone/Fax

Practice location:
  • Phone: 727-825-1491
  • Fax:
Mailing address:
  • Phone: 727-641-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS8604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: