Provider Demographics
NPI:1104841915
Name:DAJAC, ROBERT SOLANO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SOLANO
Last Name:DAJAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-282-6331
Mailing Address - Fax:904-282-4117
Practice Address - Street 1:5445 NORWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-5008
Practice Address - Country:US
Practice Address - Phone:904-765-7075
Practice Address - Fax:904-765-6325
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379008800Medicaid
FL080148951OtherMEDICARE RAILROAD
FL379008800Medicaid
FL28418ZMedicare PIN