Provider Demographics
NPI:1124067269
Name:MCDONALD, ROBERT JOHN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:MCDONALD
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 102222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-432-8500
Mailing Address - Fax:
Practice Address - Street 1:295 GREEN DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:PLACIDA
Practice Address - State:FL
Practice Address - Zip Code:33946-2236
Practice Address - Country:US
Practice Address - Phone:855-327-6003
Practice Address - Fax:855-271-8072
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051842207U00000X
FLME518422085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258700900Medicaid
2324753OtherAETNA HMO
FL10715379OtherCAQH
04699OtherBCBS
4388637OtherAETNA PPO
FLME51842OtherFLORIDA LICENSE
04699OtherBCBS
FLME51842OtherFLORIDA LICENSE
FL04699XMedicare PIN