Basic Information
| Provider Information | |||||||||
| NPI: | 1225209083 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT F VASSALL MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15757 PINES BLVD STE 107 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330271207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544479938 | ||||||||
| FaxNumber: | 9544479431 | ||||||||
| Practice Location | |||||||||
| Address1: | 2813 EXECUTIVE PARK DR STE 140 | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544479938 | ||||||||
| FaxNumber: | 9544479431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | VASSALL | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | FITZGERALD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9544479938 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME75365 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.