Healthcare Provider Details

I. General information

NPI: 1255483616
Provider Name (Legal Business Name): ROBERT E GROBLE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 BARRS STREET
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

1510 BARRS STREET
JACKSONVILLE FL
32204
US

V. Phone/Fax

Practice location:
  • Phone: 904-384-3354
  • Fax: 904-384-4211
Mailing address:
  • Phone: 904-384-3354
  • Fax: 904-384-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2809
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME0023162
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT E GROBLE
Title or Position: MEDICAL DOCTOR PSYCHIATRIST
Credential: MD
Phone: 904-384-3354