Provider Demographics
NPI:1518991637
Name:WACKS, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:WACKS
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 1:1501 PRESIDENTIAL WAY
Mailing Address - Street 2:STE1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1800
Mailing Address - Country:US
Mailing Address - Phone:561-844-8899
Mailing Address - Fax:561-684-5568
Practice Address - Street 1:1501 PRESIDENTIAL WAY
Practice Address - Street 2:STE1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1800
Practice Address - Country:US
Practice Address - Phone:561-844-8899
Practice Address - Fax:561-684-5568
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0038647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79653Medicare PIN
D58874Medicare UPIN