Healthcare Provider Details

I. General information

NPI: 1992249288
Provider Name (Legal Business Name): ROBERT L DUBIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 US HIGHWAY 41 BYP S
VENICE FL
34285-5545
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 941-202-0500
  • Fax: 941-202-0501
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME88538
License Number StateFL

VIII. Authorized Official

Name: ROBERT L DUBIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 941-222-0772