Individual
DR. THEODORE G PROBST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1515 S OSPREY AVE, SUITE 1-A, SARASOTA, FL 34239-2939
(941) 917-7197
(941) 917-4016
Mailing address
PO BOX 863407, ORLANDO, FL 32886-3407
(941) 917-2600
(914) 917-7884
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME31620
FL
2084P0805X
Geriatric Psychiatry Physician
ME0031620
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
266213200
—
FL
01
—
79310
BCBS
FL
Enumeration date
05/03/2006
Last updated
03/09/2020
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