Provider Demographics
NPI:1487831350
Name:HOLE, ROBERT E (PO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HOLE
Suffix:
Gender:M
Credentials:PO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:346 N RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132-1671
Mailing Address - Country:US
Mailing Address - Phone:386-423-1888
Mailing Address - Fax:386-423-2030
Practice Address - Street 1:346 N RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132-1671
Practice Address - Country:US
Practice Address - Phone:386-423-1888
Practice Address - Fax:386-423-2030
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2489213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65415Medicare PIN
FLU43010Medicare UPIN