Provider Demographics
NPI:1407812175
Name:HASTY, ROBERT T (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:HASTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5956 CATESBY ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7270
Mailing Address - Country:US
Mailing Address - Phone:954-464-7227
Mailing Address - Fax:954-262-2276
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-4100
Practice Address - Fax:954-262-1172
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2672251 00Medicaid
FL0S8495OtherFLORIDA LICENSE
FL2672251 00Medicaid
FL0S8495OtherFLORIDA LICENSE