Provider Demographics
NPI:1164488110
Name:CANO, ROBERTO A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:A
Last Name:CANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3700 WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8256
Mailing Address - Country:US
Mailing Address - Phone:954-983-6307
Mailing Address - Fax:954-983-5809
Practice Address - Street 1:3700 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-983-6307
Practice Address - Fax:954-983-5809
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME55231174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374859600Medicaid
FL09513AMedicare PIN
FL374859600Medicaid