Provider Demographics
NPI:1386862415
Name:BADER, ROBERT SCOTT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:BADER
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 1:1500 EAST HILLSBORO BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-421-3200
Mailing Address - Fax:954-421-3201
Practice Address - Street 1:1500 EAST HILLSBORO BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:954-421-3200
Practice Address - Fax:954-421-3201
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77930207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG73484Medicare UPIN
FL46406WMedicare ID - Type Unspecified
FL46406YMedicare ID - Type Unspecified
FLK1596AMedicare ID - Type Unspecified
FLK1596Medicare ID - Type Unspecified