Provider Demographics
NPI:1700223278
Name:MEAD, ROBERT NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NELSON
Last Name:MEAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1399 JENKS AVE STE G
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2597
Mailing Address - Country:US
Mailing Address - Phone:318-820-0267
Mailing Address - Fax:850-215-4229
Practice Address - Street 1:1399 JENKS AVE STE G
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2597
Practice Address - Country:US
Practice Address - Phone:850-771-2001
Practice Address - Fax:850-215-4229
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA156361207XX0005X
FLME156523207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine