=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962573295
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VERA M ROBERT MD DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2006
-----------------------------------------------------
Last Update Date | 11/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12565 COLLIER BLVD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34116-5243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-455-9919
-----------------------------------------------------
Fax | 239-455-9906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2110 19TH ST SW
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34117-4724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-353-1015
-----------------------------------------------------
Fax | 239-455-9906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | VERA M ROBERT
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 239-455-9919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------