Provider Demographics
NPI:1194794941
Name:HACKETT, ROBERT EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:HACKETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3140 CELINA LANE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8477
Mailing Address - Country:US
Mailing Address - Phone:321-751-6626
Mailing Address - Fax:321-751-6626
Practice Address - Street 1:VA OUTPATIENT CLINIC
Practice Address - Street 2:2900 VETERANS WAY
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-637-3788
Practice Address - Fax:321-637-3548
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL20703208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVADOOOMedicare UPIN