Individual
ROBIN JOHN CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1825 SE TIFFANY AVE, SUITE 104, PORT ST LUCIE, FL 34952-7554
(772) 398-2233
(772) 398-2244
Mailing address
2580 NW EVENTIDE PL, STUART, FL 34994-9146
(772) 398-2233
(772) 398-2244
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME57428
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051223100
—
FL
01
—
11634
BCBS PROVIDER NUMBER
FL
Enumeration date
06/22/2006
Last updated
09/13/2019
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