Healthcare Provider Details

I. General information

NPI: 1104008143
Provider Name (Legal Business Name): DR. ROBERT KENNETH DAWES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2007
Last Update Date: 12/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7491 W OAKLAND PARK BLVD SUITE 308
TAMARAC FL
33319-4989
US

IV. Provider business mailing address

7491 W OAKLAND PARK BLVD SUITE 308
TAMARAC FL
33319-4989
US

V. Phone/Fax

Practice location:
  • Phone: 954-205-9708
  • Fax:
Mailing address:
  • Phone: 954-205-9708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY004758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: