Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME77930 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | ME77930 | FL |
N | 207ND0900X | Dermatopathologist | ME77930 | FL |
N | 207NS0135X | Procedural Dermatology | ME77930 | FL |
NPI | 1386862415 |
---|---|
Provider Name | Robert Scott Bader |
First Address | Deerfield Beach, FL 33441 |
Second Address | Deerfield Beach, FL 33441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 01/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G73484 | (02) | FL |