Provider Demographics
NPI:1629427679
Name:ELVIR, ROBERT (DOM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ELVIR
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 NW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1434
Mailing Address - Country:US
Mailing Address - Phone:305-807-5119
Mailing Address - Fax:
Practice Address - Street 1:10046 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6960
Practice Address - Country:US
Practice Address - Phone:305-807-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3720AP171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist