Provider Demographics
NPI:1508123829
Name:SLEDGE, ROBERT CLARK JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLARK
Last Name:SLEDGE
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:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4500
Mailing Address - Fax:850-475-4619
Practice Address - Street 1:4586 E HIGHWAY 20 STE A
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9724
Practice Address - Country:US
Practice Address - Phone:850-897-0110
Practice Address - Fax:850-897-1626
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136689207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I160886Medicare PIN