Provider Demographics
NPI:1790089407
Name:ROBERT S CAPUTO D.O.,P.A.
Entity Type:Organization
Organization Name:ROBERT S CAPUTO D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:850-398-8873
Mailing Address - Street 1:194 E REDSTONE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5368
Mailing Address - Country:US
Mailing Address - Phone:850-398-8873
Mailing Address - Fax:850-398-8897
Practice Address - Street 1:194 E REDSTONE AVE STE B
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5368
Practice Address - Country:US
Practice Address - Phone:850-398-8873
Practice Address - Fax:850-398-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S005464207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE52034Medicare UPIN