Healthcare Provider Details

I. General information

NPI: 1225209083
Provider Name (Legal Business Name): ROBERT F VASSALL MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 ORANGE DR STE 117
DAVIE FL
33330-4304
US

IV. Provider business mailing address

15757 PINES BLVD STE 107
PEMBROKE PINES FL
33027-1207
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-9938
  • Fax: 954-447-9431
Mailing address:
  • Phone: 954-447-9938
  • Fax: 954-447-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME75365
License Number StateFL

VIII. Authorized Official

Name: ROBERT FITZGERALD VASSALL
Title or Position: PRESIDENT
Credential: MD
Phone: 954-447-9938