Provider Demographics
NPI:1487763116
Name:SAVAGE, ROBERT A (P A)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 DUVAL DR
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7073
Mailing Address - Country:US
Mailing Address - Phone:954-974-6346
Mailing Address - Fax:
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 308
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-912-9580
Practice Address - Fax:561-912-9506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3105363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2732XMedicare ID - Type Unspecified
FLS83758Medicare UPIN