Provider Demographics
NPI:1457362311
Name:NUZUM, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:NUZUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4120 WOODMERE PARK BLVD
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5373
Mailing Address - Country:US
Mailing Address - Phone:941-408-8855
Mailing Address - Fax:
Practice Address - Street 1:4120 WOODMERE PARK BLVD
Practice Address - Street 2:SUITE 8B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5373
Practice Address - Country:US
Practice Address - Phone:941-408-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42690207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27074Medicare UPIN