Healthcare Provider Details

I. General information

NPI: 1104321058
Provider Name (Legal Business Name): ROBERT WASSEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA ST
OAK HARBOR WA
98278-4927
US

IV. Provider business mailing address

1611 NW 12TH AVE # C600A
MIAMI FL
33136-1096
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9915
  • Fax:
Mailing address:
  • Phone: 305-585-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: