Provider Demographics
NPI:1811109978
Name:IGNASIAK, ROBERT L JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:IGNASIAK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-0289
Mailing Address - Country:US
Mailing Address - Phone:850-835-4333
Mailing Address - Fax:850-835-4311
Practice Address - Street 1:2734 E COUNTY HIGHWAY 30A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-6203
Practice Address - Country:US
Practice Address - Phone:850-534-0173
Practice Address - Fax:850-534-3078
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME41271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67023Medicare ID - Type Unspecified
FLD57745Medicare UPIN