Provider Demographics
NPI:1588699797
Name:JAEGER, ROBERT M (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:JAEGER
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PALERMO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6607
Mailing Address - Country:US
Mailing Address - Phone:305-384-8624
Mailing Address - Fax:754-300-3262
Practice Address - Street 1:315 PALERMO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6607
Practice Address - Country:US
Practice Address - Phone:305-384-8624
Practice Address - Fax:754-300-3262
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2119861207Q00000X
TXT2636207R00000X
FLOS10028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1935602Medicaid
FLBQ276YMedicare PIN
NYG90488Medicare UPIN
FLFN714AMedicare PIN
FLBQ276ZMedicare PIN
NY919251Medicare PIN