Individual
ROBERT A IANNACONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM, P.A.
Contact information
Practice address
691 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-1998
(772) 878-0040
(772) 878-4265
Mailing address
691 SW PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34953-1998
(772) 878-0040
(778) 878-4265
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO0002344
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1158590001
MEDICARE DME
—
05
—
390134300
—
FL
01
—
5400043
AETNA
—
01
—
6200153
GHI
—
01
—
65302
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/26/2005
Last updated
11/08/2023
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