=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871581900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT E TOMAS DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2005
-----------------------------------------------------
Last Update Date | 08/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12650 WORLD PLAZA LN BLDG 72 SUITE 1
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-3987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-243-8222
-----------------------------------------------------
Fax | 239-236-1595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12650 WORLD PLAZA LANE, BUILDING 72 SUITE 1
-----------------------------------------------------
City | FT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-243-8222
-----------------------------------------------------
Fax | 239-236-1595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | OS9878
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------