Provider Demographics
NPI:1689718298
Name:ANDERSON, ROBERT WILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILEY
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8880 UNIVERSITY PKWY
Mailing Address - Street 2:FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-4911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8880 UNIVERSITY PKWY
Practice Address - Street 2:FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-4911
Practice Address - Country:US
Practice Address - Phone:850-494-5939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine