Provider Demographics
NPI:1700175304
Name:APPLEBAUM, ROBERT JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JORDAN
Last Name:APPLEBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:717 S ORLEANS AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2500
Mailing Address - Country:US
Mailing Address - Phone:813-857-5868
Mailing Address - Fax:
Practice Address - Street 1:1247 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4673
Practice Address - Country:US
Practice Address - Phone:863-688-5604
Practice Address - Fax:863-682-6052
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116761207W00000X, 390200000X, 207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program