Provider Demographics
NPI:1720137938
Name:MACHLER, THEODORE J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:MACHLER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THEODORE
Other - Middle Name:J
Other - Last Name:MACHLER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD, PA
Mailing Address - Street 1:6740 CROSSWINDS DR N
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8606
Mailing Address - Country:US
Mailing Address - Phone:727-381-5775
Mailing Address - Fax:727-381-9895
Practice Address - Street 1:6740 CROSSWINDS DRIVE N
Practice Address - Street 2:SUITE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-381-5775
Practice Address - Fax:727-381-9895
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL52611OtherBLUE CROSS/ BLUE SHEILD
FL52611Medicare PIN