MEDICARE: DR. ROBERT FITZGERALD VASSALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0075365	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	K7618	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	42906	OTHER	FL	BLUECROSSBLUESHIELD#
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639254147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT FITZGERALD VASSALL M.D.

Provider Business Mailing Address
First Line	:	8201 PETERS RD
Second Line	:	SUITE 1000
City	:	PLANTATION
State	:	FL
Zip	:	33324-3265
Country	:	US
Telephone Number	:	954-447-9938
Fax Number	:	954-447-9431

Provider Business Practice Location Address
First Line	:	8201 PETERS RD
Second Line	:	SUITE 1000
City	:	PLANTATION
State	:	FL
Zip	:	33324-3265
Country	:	US
Telephone Number	:	954-447-9938
Fax Number	:	954-447-9431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	06/26/2015

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