Provider Demographics
NPI:1255471199
Name:FOLSOM, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 S HEATHWOOD DR
Mailing Address - Street 2:BUILDING B SUITE A 2ND FLOOR
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-5026
Mailing Address - Country:US
Mailing Address - Phone:239-624-8180
Mailing Address - Fax:239-624-8181
Practice Address - Street 1:40 S HEATHWOOD DR
Practice Address - Street 2:BUILDING B SUITE A 2ND FLOOR
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-5026
Practice Address - Country:US
Practice Address - Phone:239-624-8180
Practice Address - Fax:239-624-8181
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0030608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376061800Medicaid
11100Medicare ID - Type Unspecified
FL376061800Medicaid