Provider Demographics
NPI:1043322605
Name:BARDEN, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BARDEN
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 1:1282 US HIGHWAY 1
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2747
Mailing Address - Country:US
Mailing Address - Phone:321-632-4800
Mailing Address - Fax:321-632-6320
Practice Address - Street 1:1282 US HIGHWAY 1
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2747
Practice Address - Country:US
Practice Address - Phone:321-632-4800
Practice Address - Fax:321-632-6320
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61487207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370924800Medicaid
FL17792ZMedicare ID - Type Unspecified
FLE59843Medicare UPIN