Provider Demographics
NPI:1619053766
Name:DEAN, ROBERT M
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:DEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N WEST SHORE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5759
Mailing Address - Country:US
Mailing Address - Phone:813-575-5276
Mailing Address - Fax:813-315-7061
Practice Address - Street 1:2202 N WEST SHORE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5759
Practice Address - Country:US
Practice Address - Phone:813-575-5276
Practice Address - Fax:813-315-7061
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04-94379Medicare ID - Type Unspecified
FLG53609Medicare UPIN