Provider Demographics
NPI:1245236298
Name:PIMENTEL, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:PIMENTEL
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:PO BOX 9100
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9100
Mailing Address - Country:US
Mailing Address - Phone:613-002-4105
Mailing Address - Fax:
Practice Address - Street 1:8320 W SUNRISE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5434
Practice Address - Country:US
Practice Address - Phone:954-791-2810
Practice Address - Fax:954-791-9810
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163589207V00000X, 207V00000X
IL036098366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
042610OtherHEALTH ALLIANCE
4796890023OtherDMERC
FLME163589OtherFL MEDICAL LICENSE
IL036098366Medicaid
91382OtherWELLMARK BC/BS
209860OtherIOWA HEALTH SOLUTIONS
IL01F4OtherJOHN DEERE HEALTH PLAN
IA0589424Medicaid
IA0589424Medicaid