Healthcare Provider Details

I. General information

NPI: 1730164161
Provider Name (Legal Business Name): ROBERT GEORGE VALENTINE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 NW 11TH PL STE A
GAINESVILLE FL
32605-4216
US

IV. Provider business mailing address

11350 MCCORMICK RD EXECUTIVE PLAZA 1, STE. 501
HUNT VALLEY MD
21031-7607
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3353
  • Fax: 352-333-9035
Mailing address:
  • Phone: 703-914-8000
  • Fax: 352-333-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME82864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: