Provider Demographics
NPI:1659332732
Name:COLLETTE, ROBERT PATRICK (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PATRICK
Last Name:COLLETTE
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 1:1426 CARING CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4252
Mailing Address - Country:US
Mailing Address - Phone:407-687-9087
Mailing Address - Fax:
Practice Address - Street 1:763 HARLEY STRICKLAND BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7962
Practice Address - Country:US
Practice Address - Phone:386-775-4467
Practice Address - Fax:386-775-8679
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59513207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL593466213OtherTAX IDENTIFICATION
FL11984Medicare ID - Type Unspecified
FLE82548Medicare UPIN