Provider Demographics
NPI:1619972387
Name:DEEM, ROBERT B (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:DEEM
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 1:1549 S JEFFERSON
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1651
Mailing Address - Country:US
Mailing Address - Phone:850-997-0707
Mailing Address - Fax:850-997-6833
Practice Address - Street 1:1549 S JEFFERSON
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1651
Practice Address - Country:US
Practice Address - Phone:850-997-0707
Practice Address - Fax:850-997-6833
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0096771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-3409OtherRURAL MEDICARE GROUP #
FL276370200Medicaid
FL56525OtherBLUE CROSS BLUE SHIELD
FL660037901OtherRURAL MEDICAID
FLAC462ZMedicare PIN
FL10-3409OtherRURAL MEDICARE GROUP #