Provider Demographics
NPI:1245209030
Name:RABOW, FRED I (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:I
Last Name:RABOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 W SWANN AVE
Mailing Address - Street 2:STE 105B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4049
Mailing Address - Country:US
Mailing Address - Phone:813-870-1747
Mailing Address - Fax:813-876-8561
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4095
Practice Address - Country:US
Practice Address - Phone:813-870-1747
Practice Address - Fax:813-876-8561
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031296174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038190000Medicaid
FL30069Medicare PIN
FLE14460Medicare UPIN