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General NPI Number Information
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NPI Number | 1790772770
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Entity Type | Individual
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Provider Name | ROBERT A FASOLI MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 2210 61ST ST W
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City | BRADENTON
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State | FL
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Zip | 34209-5527
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Country | US
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Telephone | 941-792-0611
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Fax | 941-792-0086
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Provider Business Mailing Address
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Address Line | 2210 61ST ST W
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City | BRADENTON
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State | FL
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Zip | 34209-5527
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Country | US
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Telephone | 941-792-0611
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Fax | 941-792-0086
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MEOO35792
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME0035792
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License Number State | FL
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