MEDICARE: DR. ROBERT S FOGARTY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0006917	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891778825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT S FOGARTY DC

Provider Business Mailing Address
First Line	:	12484 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7100
Country	:	US
Telephone Number	:	407-281-0707
Fax Number	:	407-273-4793

Provider Business Practice Location Address
First Line	:	12484 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7100
Country	:	US
Telephone Number	:	407-281-0707
Fax Number	:	407-273-4793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	02/28/2014

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