Provider Demographics
NPI:1174504914
Name:ATWELL, J ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:ROBIN
Last Name:ATWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1355 37TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7321
Mailing Address - Country:US
Mailing Address - Phone:772-569-7606
Mailing Address - Fax:772-569-7628
Practice Address - Street 1:1355 37TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-7321
Practice Address - Country:US
Practice Address - Phone:772-569-7606
Practice Address - Fax:772-569-7628
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0044212208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL044006000Medicaid
FL044006000Medicaid
FLD85608Medicare UPIN