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Organization

VEIN ASSOCIATES, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ROBERT JAMES THEOBALD III DO (PHYSICIAN)
(803) 808-8070
Entity
Organization

Contact information

Practice address
400 INTERNATIONAL PKWY, SUITE 100, HEATHROW, FL 32746-5061
(803) 808-8070
(803) 808-8074
Mailing address
PO BOX 863550, ORLANDO, FL 32886-3550
(803) 808-8070
(803) 808-8074

Taxonomy

Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
53M96RE
BCBS GROUP NUMBER
MN
01
97985
BCBS GROUP NUMBER
FL
Enumeration date
06/30/2006
Last updated
07/22/2008
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