Provider Demographics
NPI:1396044434
Name:ROBERT A ALTHAR MD
Entity Type:Organization
Organization Name:ROBERT A ALTHAR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALTHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-995-0875
Mailing Address - Street 1:4225 WOODBINE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8790
Mailing Address - Country:US
Mailing Address - Phone:850-995-0875
Mailing Address - Fax:850-995-0854
Practice Address - Street 1:4225 WOODBINE RD
Practice Address - Street 2:SUITE C
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8790
Practice Address - Country:US
Practice Address - Phone:850-995-0875
Practice Address - Fax:850-995-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty