Provider Demographics
NPI:1356319024
Name:LUFKIN, ROBERT WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALTER
Last Name:LUFKIN
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 1:648 APALACHEE CIR NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2722
Mailing Address - Country:US
Mailing Address - Phone:727-577-5110
Mailing Address - Fax:
Practice Address - Street 1:648 APALACHEE CIR NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2722
Practice Address - Country:US
Practice Address - Phone:727-577-5110
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037132207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62269Medicare ID - Type Unspecified
FLD57378Medicare UPIN