Provider Demographics
NPI:1326255134
Name:MISSIRIAN, ROBERE JANNIK (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERE
Middle Name:JANNIK
Last Name:MISSIRIAN
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 1:1730 S FEDERAL HWY # 199
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3309
Mailing Address - Country:US
Mailing Address - Phone:877-848-2507
Mailing Address - Fax:954-951-1285
Practice Address - Street 1:4848 COCONUT CREEK PKWY # 200
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3904
Practice Address - Country:US
Practice Address - Phone:877-848-2507
Practice Address - Fax:954-951-1285
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG84264207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73408Medicare UPIN
CAG84264CMedicare ID - Type Unspecified