Provider Demographics
NPI:1134322407
Name:KONFORTI, ROBERT (AP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KONFORTI
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 12TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3791
Mailing Address - Country:US
Mailing Address - Phone:772-562-0477
Mailing Address - Fax:772-562-7677
Practice Address - Street 1:1125 12TH ST STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3791
Practice Address - Country:US
Practice Address - Phone:772-562-0477
Practice Address - Fax:772-562-7677
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1107171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0457OtherBCBS PROVIDER NUMBER