Provider Demographics
NPI:1255483616
Name:ROBERT E GROBLE MD PA
Entity Type:Organization
Organization Name:ROBERT E GROBLE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GROBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-384-3354
Mailing Address - Street 1:1510 BARRS STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-384-3354
Mailing Address - Fax:904-384-4211
Practice Address - Street 1:1510 BARRS STREET
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204
Practice Address - Country:US
Practice Address - Phone:904-384-3354
Practice Address - Fax:904-384-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2809101YM0800X
FLME00231622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0066500200Medicaid
FL0066500200Medicaid
=========OtherUSA ASSIGNED FOR OTHER IN
FL15325Medicare ID - Type Unspecified