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
Update your record
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