Basic Information
| Provider Information | |||||||||
| NPI: | 1831140557 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIRAGUSA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10824 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352020824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053221808 | ||||||||
| FaxNumber: | 2053221851 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 W MORENO ST | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325012316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504378390 | ||||||||
| FaxNumber: | 8504378394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME84297 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 34093 | 01 | FL | BCBS | OTHER | 59183847 | 01 | AL | BCBS | OTHER | 59183848 | 01 | AL | BCBS | OTHER | P00192327 | 01 | PALMETTO GBA-RR MEDICARE | OTHER | P00264846 | 01 | PALMETTO GBA-RR MEDICARE | OTHER | 00458263 | 05 | MS | MEDICAID |