Provider Demographics
NPI:1780905224
Name:FRED I RABOW MD, PA
Entity type:Organization
Organization Name:FRED I RABOW MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-870-1747
Mailing Address - Street 1:2919 W SWANN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4038
Mailing Address - Country:US
Mailing Address - Phone:813-870-1747
Mailing Address - Fax:813-876-8561
Practice Address - Street 1:2919 W SWANN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4038
Practice Address - Country:US
Practice Address - Phone:813-870-1747
Practice Address - Fax:813-876-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031296207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038190000Medicaid
FLE14460Medicare UPIN
FL038190000Medicaid