Provider Demographics
NPI:1225209083
Name:ROBERT F VASSALL MD PA
Entity Type:Organization
Organization Name:ROBERT F VASSALL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:VASSALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-447-9938
Mailing Address - Street 1:15757 PINES BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1207
Mailing Address - Country:US
Mailing Address - Phone:954-447-9938
Mailing Address - Fax:954-447-9431
Practice Address - Street 1:2813 EXECUTIVE PARK DR STE 140
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3603
Practice Address - Country:US
Practice Address - Phone:954-447-9938
Practice Address - Fax:954-447-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME753652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7618Medicare PIN