Provider Demographics
NPI:1073960357
Name:SOLOMON, ROBERT JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SOLOMON
Suffix:JR
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 1:1431 ORANGE CAMP RD STE 118119
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7768
Mailing Address - Country:US
Mailing Address - Phone:386-943-3234
Mailing Address - Fax:
Practice Address - Street 1:1431 ORANGE CAMP RD STE 118119
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724
Practice Address - Country:US
Practice Address - Phone:386-943-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-17
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL138202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty