Provider Demographics
NPI:1235163916
Name:ENNIS, ROBERT STEPHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEPHAN
Last Name:ENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 STALLION LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3035
Mailing Address - Country:US
Mailing Address - Phone:305-542-4768
Mailing Address - Fax:954-349-4452
Practice Address - Street 1:3455 STALLION LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3035
Practice Address - Country:US
Practice Address - Phone:305-542-4768
Practice Address - Fax:954-349-4452
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 20284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery