Provider Demographics
NPI:1245077817
Name:ANNEAS, BOB
Entity type:Individual
Prefix:
First Name:BOB
Middle Name:
Last Name:ANNEAS
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 1:8834 N 56TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6214
Mailing Address - Country:US
Mailing Address - Phone:813-296-9109
Mailing Address - Fax:
Practice Address - Street 1:8834 N 56TH ST STE C
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-6214
Practice Address - Country:US
Practice Address - Phone:813-296-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver