Provider Demographics
NPI:1982653226
Name:VOLLBRACHT, ROBERT LEONARD (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEONARD
Last Name:VOLLBRACHT
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 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3398
Mailing Address - Country:US
Mailing Address - Phone:727-443-3295
Mailing Address - Fax:727-446-4336
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3398
Practice Address - Country:US
Practice Address - Phone:727-443-3295
Practice Address - Fax:727-446-4336
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00293482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268786100Medicaid
FL62190OtherBLUE CROSS BLUE SHIELD
FL4566540OtherAETNA
FL268786100Medicaid
FL62190ZMedicare ID - Type Unspecified