Basic Information
| Provider Information | |||||||||
| NPI: | 1487655155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALTHAR | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 W LAKEVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325011836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504693500 | ||||||||
| FaxNumber: | 8505951400 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 W LAKEVIEW AVE | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325011836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504693500 | ||||||||
| FaxNumber: | 8505951400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 11/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A0401X | ME49321 | FL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2086S0105X | ME49321 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | 208D00000X | ME49321 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 104588400 | 05 | FL | MEDICAID |