Provider Demographics
NPI:1255412441
Name:BASILICO, ROBERT FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANCIS
Last Name:BASILICO
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 1:8037 LINKS WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3036
Mailing Address - Country:US
Mailing Address - Phone:772-466-2364
Mailing Address - Fax:772-466-6095
Practice Address - Street 1:2401 FRIST BOULEVARD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-595-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 36392207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology