Provider Demographics
NPI:1740285006
Name:SAYRE, ROBERT BLAKE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT BLAKE
Middle Name:
Last Name:SAYRE
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 1:14 W JORDAN ST STE C
Mailing Address - Street 2:STE 1
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1737
Mailing Address - Country:US
Mailing Address - Phone:850-434-0077
Mailing Address - Fax:850-546-6122
Practice Address - Street 1:14 W JORDAN ST STE C
Practice Address - Street 2:STE 1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1737
Practice Address - Country:US
Practice Address - Phone:850-434-0077
Practice Address - Fax:850-546-6122
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME80025OtherFLORIDA MEDICAL LICENSE
FL263571200Medicaid
FL263571200Medicaid
FL010583165OtherFEDERAL TAX ID NUMBER
FL263571200Medicaid