Provider Demographics
NPI:1053702134
Name:ROBERT R. TAWIL
Entity type:Organization
Organization Name:ROBERT R. TAWIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-254-4262
Mailing Address - Street 1:3741 W NEPTUNE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5118
Mailing Address - Country:US
Mailing Address - Phone:813-254-4262
Mailing Address - Fax:813-251-6415
Practice Address - Street 1:3741 W NEPTUNE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5118
Practice Address - Country:US
Practice Address - Phone:813-254-4262
Practice Address - Fax:813-251-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070001775OtherRAILROAD MEDICARE
FL30919OtherBC/BS
FL30919OtherBC/BS