Provider Demographics
NPI:1639254147
Name:VASSALL, ROBERT FITZGERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FITZGERALD
Last Name:VASSALL
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 1:8201 PETERS RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3265
Mailing Address - Country:US
Mailing Address - Phone:954-447-9938
Mailing Address - Fax:954-447-9431
Practice Address - Street 1:8201 PETERS RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3265
Practice Address - Country:US
Practice Address - Phone:954-447-9938
Practice Address - Fax:954-447-9431
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00753652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253811302Medicaid
FL253811303Medicaid
FL42906OtherBLUECROSSBLUESHIELD#
FLK7618OtherMEDICARE PTAN
FL253811303Medicaid