Provider Demographics
NPI:1275651093
Name:THOBURN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:THOBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9409 SW 47TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7112
Mailing Address - Country:US
Mailing Address - Phone:352-485-1133
Mailing Address - Fax:352-485-2927
Practice Address - Street 1:23320 N STATE ROAD 235
Practice Address - Street 2:
Practice Address - City:BROOKER
Practice Address - State:FL
Practice Address - Zip Code:32622-5266
Practice Address - Country:US
Practice Address - Phone:352-485-1133
Practice Address - Fax:352-485-2927
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0021981207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054559700Medicaid
FLD82290Medicare UPIN
FL054559700Medicaid