Provider Demographics
NPI:1417192097
Name:HERBST, ROBERT J (AP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:HERBST
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5576 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3423
Mailing Address - Country:US
Mailing Address - Phone:954-586-2273
Mailing Address - Fax:
Practice Address - Street 1:5576 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3423
Practice Address - Country:US
Practice Address - Phone:954-586-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2502171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9085464OtherCIGNA
FLCOOEVOtherBCBS FLORIDA