Provider Demographics
NPI:1992896120
Name:UTEG, ROBERT P (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:P
Last Name:UTEG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:P.O. BOX 5515
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34674-5515
Mailing Address - Country:US
Mailing Address - Phone:727-868-9563
Mailing Address - Fax:727-869-6909
Practice Address - Street 1:7315 HUDSON AV.
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-868-9563
Practice Address - Fax:727-869-6909
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18342207T00000X
FLME105701207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00472372Medicaid
MS3852936Medicare PIN
E64468Medicare UPIN
MS00472372Medicaid
MSE64468Medicare UPIN