Provider Demographics
NPI:1841290681
Name:KILLEEN, ROBERT BRUCE JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:KILLEEN
Suffix:JR
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 1:2520 US HWY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691
Mailing Address - Country:US
Mailing Address - Phone:727-945-0515
Mailing Address - Fax:727-934-4045
Practice Address - Street 1:2520 US HWY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691
Practice Address - Country:US
Practice Address - Phone:727-945-0515
Practice Address - Fax:727-934-4045
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58217207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054208300Medicaid
12253Medicare ID - Type Unspecified
FL054208300Medicaid