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NPI Code Detail

MEDICARE: DR. ROBERT S BAIN JR. M.D.

MEDICARE: DR. ROBERT S BAIN JR. M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician40125KY
22085R0202XDiagnostic Radiology PhysicianME104942FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2145SJOTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720085004
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT S BAIN JR. M.D.
Provider Business Mailing Address
First Line : 4205 BELFORT RD STE 4015
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-3623
Country : US
Telephone Number : 904-450-6014
Fax Number : 904-450-6401
Provider Business Practice Location Address
First Line : 615 N BONITA AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-3623
Country : US
Telephone Number : 850-769-1511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2005
Last Update Date : 02/12/2020

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Directions to “ DR. ROBERT S BAIN JR. M.D.” Practice Location

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