Provider Demographics
NPI:1538438007
Name:ROBERT D FLURRY MD PA
Entity type:Organization
Organization Name:ROBERT D FLURRY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-472-0123
Mailing Address - Street 1:9290 BALDRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5505
Mailing Address - Country:US
Mailing Address - Phone:850-472-0123
Mailing Address - Fax:850-472-0122
Practice Address - Street 1:9290 BALDRIDGE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5505
Practice Address - Country:US
Practice Address - Phone:850-472-0123
Practice Address - Fax:850-472-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58950302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370157300Medicaid
FLE78982Medicare UPIN