Healthcare Provider Details

I. General information

NPI: 1689031619
Provider Name (Legal Business Name): ROBERT SACKHEIM,M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
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: 850-637-4645
  • Fax: 850-433-8641
Mailing address:
  • Phone: 850-637-4645
  • Fax: 850-433-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME0042339
License Number StateFL

VIII. Authorized Official

Name: MARLENE SACKHEIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 850-637-4645