Healthcare Provider Details

I. General information

NPI: 1629008073
Provider Name (Legal Business Name): ROBERT LAURENCE GRIFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR STE 304
JACKSONVILLE FL
32207-8205
US

IV. Provider business mailing address

60 ROBERTS VILLAGE CT
SAINT JOHNS FL
32259-9561
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-3860
  • Fax: 904-202-3846
Mailing address:
  • Phone: 904-230-8365
  • Fax: 904-667-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME95659
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME95659
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME95659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: