Healthcare Provider Details

I. General information

NPI: 1780905224
Provider Name (Legal Business Name): FRED I RABOW MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 06/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 W SWANN AVE SUITE 203
TAMPA FL
33609-4038
US

IV. Provider business mailing address

2919 W SWANN AVE SUITE 203
TAMPA FL
33609-4038
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-1747
  • Fax: 813-876-8561
Mailing address:
  • Phone: 813-870-1747
  • Fax: 813-876-8561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0031296
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0031296
License Number StateFL

VIII. Authorized Official

Name: APRIL PUTNAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-870-1747