Provider Demographics
NPI:1275571572
Name:HADDAD, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:HADDAD
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 1:16970 SAN CARLOS BLVD STE 160 BOX 183
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-446-7038
Mailing Address - Fax:949-695-3366
Practice Address - Street 1:3201 TAMIAMI TRL N STE 139
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4135
Practice Address - Country:US
Practice Address - Phone:239-446-7038
Practice Address - Fax:949-695-3366
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146W0OtherBCBS
FLP00806516OtherRR MEDICARE
FLCV111ZOtherMEDICARE
FL9577463OtherAETNA
FL001695000Medicaid
FL297329OtherCIGNA