Provider Demographics
NPI:1073512695
Name:CASE, ROBERT M (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CASE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2866 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5165
Mailing Address - Country:US
Mailing Address - Phone:941-629-3535
Mailing Address - Fax:941-625-2076
Practice Address - Street 1:2866 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5126
Practice Address - Country:US
Practice Address - Phone:941-629-3535
Practice Address - Fax:941-625-2076
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLP0929213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87617OtherBLUE CROSS BLUE SHIELD
FLT55473Medicare UPIN
1043900001Medicare NSC
FL87617Medicare PIN