Provider Demographics
NPI:1124175930
Name:MIDDLETON, ROBERT C (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MIDDLETON
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 1:98 TERRA MANGO LOOP STE 12
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8515
Mailing Address - Country:US
Mailing Address - Phone:407-354-0717
Mailing Address - Fax:407-354-5436
Practice Address - Street 1:98 TERRA MANGO LOOP STE 12
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8515
Practice Address - Country:US
Practice Address - Phone:407-354-0717
Practice Address - Fax:407-354-5436
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99544208000000X
MI4301073807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024428300Medicaid
RM073807OtherCHAMPUS-CHAMPUS
MI453319710Medicaid
700H262280OtherBLUE CROSS-BLUE CROSS
0H26228330Medicare ID - Type Unspecified
700H262280OtherBLUE CROSS-BLUE CROSS