Provider Demographics
NPI:1467454330
Name:PURDON, ROBERT LAKE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAKE
Last Name:PURDON
Suffix:
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 1:2020 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4118
Mailing Address - Country:US
Mailing Address - Phone:352-861-0440
Mailing Address - Fax:352-861-1869
Practice Address - Street 1:1540 CLEMENTE CT
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8960
Practice Address - Country:US
Practice Address - Phone:352-259-2200
Practice Address - Fax:352-259-2203
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME434892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35205UOtherMEDICARE ID-TYPE UNSPECIFIED
FL068969600Medicaid
FLME43489OtherMEDICAL LIC