Provider Demographics
NPI:1255368098
Name:MCCANN, ROBERT K (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:MCCANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7303 DUNES CT
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4047
Mailing Address - Country:US
Mailing Address - Phone:941-737-8594
Mailing Address - Fax:941-359-3203
Practice Address - Street 1:7303 DUNES CT
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-4047
Practice Address - Country:US
Practice Address - Phone:941-737-8594
Practice Address - Fax:941-359-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7355207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE38430Medicare UPIN
FL57531FMedicare ID - Type Unspecified