Healthcare Provider Details

I. General information

NPI: 1336646017
Provider Name (Legal Business Name): ADAM HENRY KOBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

IV. Provider business mailing address

322 W GIDDENS AVE
TAMPA FL
33603-1935
US

V. Phone/Fax

Practice location:
  • Phone: 813-627-5931
  • Fax:
Mailing address:
  • Phone: 954-609-8056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME147313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: