Provider Demographics
NPI:1558466599
Name:BERMAN, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 ALTERNATE A1A SOUTH
Mailing Address - Street 2:SUITE 450
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-4063
Mailing Address - Country:US
Mailing Address - Phone:561-743-5112
Mailing Address - Fax:561-743-8567
Practice Address - Street 1:2141 ALTERNATE A1A SOUTH
Practice Address - Street 2:SUITE 450
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4063
Practice Address - Country:US
Practice Address - Phone:561-743-5112
Practice Address - Fax:561-743-8567
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058889208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C74454Medicare UPIN
FL12853Medicare ID - Type Unspecified