Provider Demographics
NPI:1427040310
Name:GUAGENTI, ROBERT C (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:GUAGENTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12255 LONGVIEW LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4972
Mailing Address - Country:US
Mailing Address - Phone:941-907-2696
Mailing Address - Fax:941-907-2696
Practice Address - Street 1:10000 BAY PINES BLVD
Practice Address - Street 2:BLDG 100- 4C-GASTROENTEROLOGY
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744-8200
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9579
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6728207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260329200Medicaid
FL260329200Medicaid