Provider Demographics
NPI:1396745147
Name:FLURRY, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FLURRY
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 1:9290 BALDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5505
Mailing Address - Country:US
Mailing Address - Phone:850-472-0123
Mailing Address - Fax:850-472-0122
Practice Address - Street 1:9290 BALDRIDGE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5505
Practice Address - Country:US
Practice Address - Phone:850-472-0123
Practice Address - Fax:850-472-0122
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370157300Medicaid
FL11799Medicare UPIN
FLE78982Medicare UPIN
FL370157300Medicaid