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NPI Code Detail

MEDICARE: ROBERT W DEMETRIUS MD

MEDICARE: ROBERT W DEMETRIUS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery PhysicianME 68919FL
2207NS0135XProcedural Dermatology PhysicianME 68919FL

General Provider Information

NPI Number : 1386603009
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT W DEMETRIUS MD
Provider Business Mailing Address
First Line : 2850 MORNINGSIDE DR
Second Line :
City : MOUNT DORA
State : FL
Zip : 32757-6610
Country : US
Telephone Number : 352-383-0733
Fax Number : 352-383-7114
Provider Business Practice Location Address
First Line : 2850 MORNINGSIDE DR
Second Line :
City : MOUNT DORA
State : FL
Zip : 32757-6610
Country : US
Telephone Number : 352-383-0733
Fax Number : 352-383-7114
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 04/16/2015

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