Individual
DR. ROBERT SALVATORE DIBACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5053 S CONGRESS AVE, STE 204, ATLANTIS, FL 33461-4706
(561) 969-7300
(561) 969-6922
Mailing address
5053 S CONGRESS AVE, STE 204, LAKE WORTH, FL 33461-4706
(561) 969-7300
(561) 969-6922
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME0038989
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070012428
MEDICARE RAILROAD
FL
01
—
93992Y
BCBS
FL
01
—
ME0038989
STATE LICENSE
FL
Enumeration date
12/06/2005
Last updated
03/30/2021
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