Provider Demographics
NPI:1447363494
Name:DULBERG, ROBERT E
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DULBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4477
Mailing Address - Country:US
Mailing Address - Phone:954-457-1202
Mailing Address - Fax:
Practice Address - Street 1:800 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 23
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4477
Practice Address - Country:US
Practice Address - Phone:954-457-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED15332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM1031OtherBLUECROSS BLUE SHIELD
FL0588670001Medicare ID - Type UnspecifiedPALMETTO GBA