Provider Demographics
NPI:1962436857
Name:EBERT, ROBERT EDWIN III (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWIN
Last Name:EBERT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:11373 CORTEZ BLVD STE 408
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5406
Mailing Address - Country:US
Mailing Address - Phone:352-592-7310
Mailing Address - Fax:850-862-6148
Practice Address - Street 1:11315 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5407
Practice Address - Country:US
Practice Address - Phone:352-592-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46895207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50537Medicare UPIN
FL02488RMedicare PIN
FL02488YMedicare PIN