Provider Demographics
NPI:1831163476
Name:PAXSON, ROBERT H (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:PAXSON
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 1:5505 N ATLANTIC AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5111
Mailing Address - Country:US
Mailing Address - Phone:321-613-0501
Mailing Address - Fax:321-613-0502
Practice Address - Street 1:5505 N ATLANTIC AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5111
Practice Address - Country:US
Practice Address - Phone:321-613-0501
Practice Address - Fax:321-613-0502
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376966600Medicaid
FLF89972Medicare UPIN
FL376966600Medicaid