Provider Demographics
NPI:1720088982
Name:HEISER, ROBERT WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WALTER
Last Name:HEISER
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:PO BOX 62226
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-2226
Mailing Address - Country:US
Mailing Address - Phone:239-206-4919
Mailing Address - Fax:239-481-0765
Practice Address - Street 1:20 BARKLEY CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4545
Practice Address - Country:US
Practice Address - Phone:239-206-4919
Practice Address - Fax:239-481-0765
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51095207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04353YMedicare PIN
FLD20915Medicare UPIN