Healthcare Provider Details

I. General information

NPI: 1841276714
Provider Name (Legal Business Name): ROBERT MORRIS SACKHEIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 N 9TH AVE
PENSACOLA FL
32503-2443
US

IV. Provider business mailing address

4601 N 9TH AVE
PENSACOLA FL
32503-2443
US

V. Phone/Fax

Practice location:
  • Phone: 850-433-6918
  • Fax: 850-433-8641
Mailing address:
  • Phone: 850-433-6918
  • Fax: 850-433-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMEOO42339
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number00019674
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: