Healthcare Provider Details

I. General information

NPI: 1538154976
Provider Name (Legal Business Name): DOUGLAS JOHN ROBB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BAYSHORE BLVD
TAMPA FL
33621-1607
US

IV. Provider business mailing address

2831 BAYSHORE TRAILS DR
TAMPA FL
33611-5525
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9545
  • Fax:
Mailing address:
  • Phone: 813-835-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberOS5227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: