Provider Demographics
NPI:1033118799
Name:LURATE, ROBERT BARRY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BARRY
Last Name:LURATE
Suffix:
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 1:2130 E JOHNSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6065
Mailing Address - Country:US
Mailing Address - Phone:850-494-6839
Mailing Address - Fax:
Practice Address - Street 1:2130 E JOHNSON AVE STE 130
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6065
Practice Address - Country:US
Practice Address - Phone:850-494-6839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-01-27
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
FLME0069522174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009709120Medicaid
FL31783OtherBCBS
5173539OtherAETNA
FL252676000Medicaid
AL59150317OtherBCBS
FL4620190001Medicare NSC
FL31783OtherBCBS
G46647Medicare UPIN