Healthcare Provider Details

I. General information

NPI: 1043365547
Provider Name (Legal Business Name): ROBERT B HEGLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 E OAKLAND PARK BLVD 3RD FLOOR
OAKLAND PARK FL
33334-2707
US

IV. Provider business mailing address

8390 CHAMPIONS GATE BLVD SUITE 215
CHAMPIONS GATE FL
33896-8310
US

V. Phone/Fax

Practice location:
  • Phone: 954-561-6900
  • Fax: 954-568-7021
Mailing address:
  • Phone: 407-390-1677
  • Fax: 407-390-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 82653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: