Healthcare Provider Details

I. General information

NPI: 1497404958
Provider Name (Legal Business Name): RAHEEM ROBERTSON MBBS (MD)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653-1 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

653-1 W 8TH ST
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-244-7514
  • Fax:
Mailing address:
  • Phone: 904-244-7514
  • Fax: 904-244-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberTRN44161
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: