Individual
DR. ROBERT JAMES THEOBALD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
14547 BRUCE B DOWNS BLVD, SUITE B, TAMPA, FL 33613-2709
(813) 875-2600
(813) 875-2626
Mailing address
38135 MARKET SQ, ZEPHYRHILLS, FL 33542-7505
(813) 780-1255
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
OS9540
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01095109
RR MEDICARE
FL
Enumeration date
07/07/2006
Last updated
08/27/2021
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