Provider Demographics
NPI:1285699025
Name:BACHUS, ROBERT WILLIAM-KIRKLAND (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM-KIRKLAND
Last Name:BACHUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PALM COAST PKWY NE
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3888
Mailing Address - Country:US
Mailing Address - Phone:386-317-8930
Mailing Address - Fax:386-295-3686
Practice Address - Street 1:315 PALM COAST PKWY NE
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3888
Practice Address - Country:US
Practice Address - Phone:386-317-8930
Practice Address - Fax:386-295-3686
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1156912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC807387Medicare PIN
COF48833Medicare UPIN