Provider Demographics
NPI:1275649766
Name:ASHLEY, ROBERT GRADY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GRADY
Last Name:ASHLEY
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:6800 NW 9TH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4231
Practice Address - Country:US
Practice Address - Phone:352-331-3300
Practice Address - Fax:352-331-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78194OtherBLUE CROSS BLUE SHIELD
FL100129OtherAVMED
FL78194Medicare ID - Type Unspecified
FLD58396Medicare UPIN