Provider Demographics
NPI:1104008143
Name:DAWES, ROBERT KENNETH
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:DAWES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7491 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4989
Mailing Address - Country:US
Mailing Address - Phone:954-205-9708
Mailing Address - Fax:
Practice Address - Street 1:7491 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4989
Practice Address - Country:US
Practice Address - Phone:954-205-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-01
Last Update Date:2007-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY004758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73977Medicare PIN