Individual
ROBERT ELIOT KUPSAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
13778 PLANTATION RD, FORT MYERS, FL 33912-4301
(239) 343-0454
(239) 343-1075
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-0454
(239) 343-1075
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME48214
FL
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
ME48214
FL
207Q00000X
Family Medicine Physician
ME48214
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043729800
—
FL
01
—
1492
BLUE CROSS BLUE SHIELD
FL
01
—
221870
AMERIGROUP
FL
01
—
297506
AVMED
FL
Enumeration date
01/01/2007
Last updated
03/29/2021
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