Provider Demographics
NPI:1669568143
Name:TAWIL, ROBERT RAPHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAPHAEL
Last Name:TAWIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 NEPTUNE STREET
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5118
Mailing Address - Country:US
Mailing Address - Phone:813-254-4262
Mailing Address - Fax:813-251-6415
Practice Address - Street 1:3741 NEPTUNE STREET
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5118
Practice Address - Country:US
Practice Address - Phone:813-254-4262
Practice Address - Fax:813-251-6415
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL59-2748330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30919Medicare ID - Type Unspecified
FLD54172Medicare UPIN