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General NPI Number Information
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NPI Number | 1720085004
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Entity Type | Individual
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Provider Name | ROBERT S BAIN JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 615 N BONITA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-3623
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Country | US
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Telephone | 850-769-1511
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Fax |
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Provider Business Mailing Address
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Address Line | 4205 BELFORT RD STE 4015
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City | JACKSONVILLE
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State | FL
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Zip | 32216-3623
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Country | US
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Telephone | 904-450-6014
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Fax | 904-450-6401
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 40125
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME104942
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License Number State | FL
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