Provider Demographics
NPI:1982739967
Name:REHNKE, ROBERT DICKERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DICKERSON
Last Name:REHNKE
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 1:6606 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-6104
Mailing Address - Country:US
Mailing Address - Phone:727-341-0337
Mailing Address - Fax:727-341-0637
Practice Address - Street 1:6606 10TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6104
Practice Address - Country:US
Practice Address - Phone:727-341-0337
Practice Address - Fax:727-341-0637
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55774208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE94127Medicare UPIN