Healthcare Provider Details

I. General information

NPI: 1467454330
Provider Name (Legal Business Name): ROBERT LAKE PURDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 CLEMENTE CT
THE VILLAGES FL
32159-8960
US

IV. Provider business mailing address

2020 SE 17TH ST
OCALA FL
34471-4118
US

V. Phone/Fax

Practice location:
  • Phone: 352-259-2200
  • Fax: 352-259-2203
Mailing address:
  • Phone: 352-861-0440
  • Fax: 352-861-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME43489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: