Most Relevant Information
Provider Data
| NPI Number: | 1003289455 |
| Provider Name: | ROBERT MATTHEW TACK PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | PA9109299 |
Most Important Dates
| Enumeration Date: | 11/06/2015 |
| Last Updated: | 02/04/2016 |
Provider Practice Location
1000 36TH ST
VERO BEACH
FL
329604862
Practice Location Phone/Fax
| Phone: | 7725674311 |
| Fax: |
Provider Mailing Location
1000 36TH ST
VERO BEACH
FL
329604862
Provider Mailing Phone/Fax
| Phone: | 7725674311 |
| Fax: |