Provider Demographics
NPI:1366750143
Name:CONNINE, TAD ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:TAD
Middle Name:ROBERT
Last Name:CONNINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23546 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-6753
Mailing Address - Country:US
Mailing Address - Phone:813-990-7443
Mailing Address - Fax:813-864-7443
Practice Address - Street 1:23546 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-6753
Practice Address - Country:US
Practice Address - Phone:813-990-7443
Practice Address - Fax:813-864-7443
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107101207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine