Provider Demographics
NPI:1588780928
Name:CHAPA, ROBERT M SR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CHAPA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 SPRING PARK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5988
Mailing Address - Country:US
Mailing Address - Phone:904-379-1203
Mailing Address - Fax:904-379-9282
Practice Address - Street 1:5600 SPRING PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5988
Practice Address - Country:US
Practice Address - Phone:904-379-1203
Practice Address - Fax:904-379-9282
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME446452083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280992300Medicaid
FLAJ833ZMedicare PIN