Healthcare Provider Details

I. General information

NPI: 1861475006
Provider Name (Legal Business Name): ROBERT RAY SCHROPE IV PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12385 SORRENTO RD
PENSACOLA FL
32507-8664
US

IV. Provider business mailing address

906 PALM BLVD S
NICEVILLE FL
32578-2603
US

V. Phone/Fax

Practice location:
  • Phone: 850-517-9851
  • Fax:
Mailing address:
  • Phone: 850-517-9851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4330
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number079199
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.005486
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1050384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: