Active NPI
Robert S Fennell III, MD
- Pediatric Nephrology Physician
- Gainesville, FL
National Provider Identifier
1679594386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nephrology Physician
- License
- ME14400
- Practice address
- 1600 SW Archer Road
Gainesville, FL 32610-0371 - Phone
- (352) 392-4434
- Fax
- (352) 392-7107
- NPI assigned
- Jul 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nephrology Physician | 2080P0210X | ME14400 | FL | Primary |
Addresses
Primary practice location
1600 SW Archer Road
Gainesville, FL 32610-0371
Mailing address
PO Box 100371
Gainesville, FL 32610-0371
Phone (352) 265-0301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME14400 | FL | MD | Pediatric Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153440000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679594386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 100371",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326100371",
"telephone_number": "352-265-0301",
"fax_number": "352-265-0627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 SW ARCHER ROAD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326100371",
"telephone_number": "352-392-4434",
"fax_number": "352-392-7107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENNELL",
"first_name": "ROBERT",
"middle_name": "S",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0210X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Nephrology",
"state": "FL",
"license": "ME14400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.