Provider Demographics
NPI:1053404046
Name:AMAZON, ROBERT A (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:AMAZON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 E CARMEL DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2812
Mailing Address - Country:US
Mailing Address - Phone:317-727-8978
Mailing Address - Fax:317-575-1702
Practice Address - Street 1:484 E CARMEL DR
Practice Address - Street 2:SUITE 207
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2812
Practice Address - Country:US
Practice Address - Phone:317-727-8978
Practice Address - Fax:317-575-1702
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000976A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200439860Medicaid
IN000000319438OtherANTHEM
INU77354Medicare UPIN
IN247650Medicare PIN