Provider Demographics
NPI:1245236298
Name:PIMENTEL, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1656
Mailing Address - Country:US
Mailing Address - Phone:563-742-5280
Mailing Address - Fax:563-742-5286
Practice Address - Street 1:8320 W SUNRISE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5434
Practice Address - Country:US
Practice Address - Phone:954-791-2810
Practice Address - Fax:954-791-9810
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-37317207V00000X
IL036098366207V00000X
FLME163589207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4796890023OtherDMERC
IA0589424Medicaid
IL01F4OtherJOHN DEERE HEALTH PLAN
IL036098366Medicaid
042610OtherHEALTH ALLIANCE
209860OtherIOWA HEALTH SOLUTIONS
91382OtherWELLMARK BC/BS
FLME163589OtherFL MEDICAL LICENSE
IA0589424Medicaid