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Provider Information for 1962436857

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ROBERT EDWIN EBERT III M.D.

Gender: MALE

Individual NPI: 1962436857

Calendar   Last Updated:  2019-01-10
  Certification Date: 

Details

Name Value
NPI 1962436857
Enumeration Date 2006-07-10
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 11373 CORTEZ BLVD STE 408
BROOKSVILLE, FL 34613-5406
United States

Phone: 352-592-7310 | Fax: 850-862-6148
View Map External Link
Primary Practice Address 11373 CORTEZ BLVD STE 408
BROOKSVILLE, FL 34613
United States

Phone: 352-592-7310 | Fax:
View Map External Link
Secondary Practice Address 11315 CORTEZ BLVD
BROOKSVILLE, FL 34613-5407
United States

Phone: 352-592-0220 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207RG0300X - Internal Medicine Geriatric Medicine FL ME46895
No 207R00000X - Internal Medicine FL ME46895