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General NPI Number Information
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NPI Number | 1053348490
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Entity Type | Individual
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Provider Name | ROBERT MARTIN DIANA P.A.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 270 S MOON AVE
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City | BRANDON
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State | FL
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Zip | 33511-5711
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Country | US
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Telephone | 813-571-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 6006 49TH ST N SUITE 310
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City | SAINT PETERSBURG
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State | FL
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Zip | 33709-2148
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Country | US
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Telephone | 727-527-9779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10034
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3668
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA09406
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9109572
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License Number State | FL
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