Provider Demographics
NPI:1619016607
Name:ROBERT H FIER MDPA
Entity Type:Organization
Organization Name:ROBERT H FIER MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:FIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-878-3437
Mailing Address - Street 1:514 SW PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8734
Mailing Address - Country:US
Mailing Address - Phone:772-878-3437
Mailing Address - Fax:772-878-1298
Practice Address - Street 1:514 SW PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-8734
Practice Address - Country:US
Practice Address - Phone:772-878-3437
Practice Address - Fax:772-878-1298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOC 3339152W00000X
FLME30598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL471650OtherCOVENTRY HEALTH CARE
FLCC9114OtherRR MEDICARE PTAN
FL471650OtherCOVENTRY HEALTH CARE