| Entity Name: | ROBERT BRUCE KILLEEN, JR., M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Oct 1993 (31 years ago) |
| Document Number: | P93000073229 |
| FEI/EIN Number | 593208813 |
| Address: | 2520 US HWY 19, HOLIDAY, FL, 34691, US |
| Mail Address: | 2520 US HWY 19, HOLIDAY, FL, 34691, US |
| ZIP code: | 34691 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730570219 | 2015-02-05 | 2015-02-05 | 2520 US HIGHWAY 19, HOLIDAY, FL, 346913846, US | 2520 US HIGHWAY 19, HOLIDAY, FL, 346913846, US | |||||||||||||||||||||||||
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| Phone | +1 727-945-0515 |
| Fax | 7279344045 |
Authorized person
| Name | DR. ROBERT BRUCE KILLEEN JR. |
| Role | PRESIDENT |
| Phone | 7279450515 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME58217 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 054208300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KILLEEN ROBERT B | Agent | 4548 BARDSDALE DR, PALM HARBOR, FL, 34685 |
| Name | Role | Address |
|---|---|---|
| KILLEEN ROBERT | Manager | 4548 BARDSDALE DR, PALM HARBOR, FL, 34685 |
| Name | Role | Address |
|---|---|---|
| KILLEEN ROBERT | Director | 4548 BARDSDALE DR, PALM HARBOR, FL, 34685 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
