Provider Demographics
NPI:1700800075
Name:MCGANN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MCGANN
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 1:1713 SW HEALTH PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0502
Mailing Address - Country:US
Mailing Address - Phone:239-597-8000
Mailing Address - Fax:239-316-1285
Practice Address - Street 1:1713 SW HEALTH PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0421
Practice Address - Country:US
Practice Address - Phone:239-597-8000
Practice Address - Fax:239-597-8095
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68636208D00000X
FLME0068636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0068636OtherLICENSE
FLAM7565697OtherDEA
FLD09933Medicare UPIN
FLAM7565697OtherDEA