Provider Demographics
NPI:1073633665
Name:ROBERT P. FEDOR, D.O.P.A
Entity Type:Organization
Organization Name:ROBERT P. FEDOR, D.O.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:EHREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-391-4100
Mailing Address - Street 1:1811 SHORE DR S
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4701
Mailing Address - Country:US
Mailing Address - Phone:727-391-4100
Mailing Address - Fax:727-398-2067
Practice Address - Street 1:1811 SHORE DR S
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4701
Practice Address - Country:US
Practice Address - Phone:727-391-4100
Practice Address - Fax:727-398-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14H46OtherBCBS ID # DR. BACON
FL002CMOtherBCBS GROUP #
FL3TQESOtherBCBS ID # DR. CARINE
FL82398OtherBCBS PROVIDER #
FLOS12209OtherMEDICAL LICENSE
FLOS10824OtherMEDICAL LICENSE
FL=========OtherTAX ID #
FLARNP2129792OtherAMY BOND-ROZELLE LICENSE