Provider Demographics
NPI:1073064739
Name:VETTER, ROBERT (HIS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VETTER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-3705
Mailing Address - Country:US
Mailing Address - Phone:941-474-8393
Mailing Address - Fax:941-474-6057
Practice Address - Street 1:655 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-3705
Practice Address - Country:US
Practice Address - Phone:941-474-8393
Practice Address - Fax:941-474-6057
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5128237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist