Provider Demographics
NPI:1053524116
Name:OESTERLE, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:OESTERLE
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 1:300 HEALTH PARK BLVD.
Mailing Address - Street 2:SUITE 3008
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3703
Mailing Address - Country:US
Mailing Address - Phone:904-810-2425
Mailing Address - Fax:904-810-5321
Practice Address - Street 1:300 HEALTH PARK BLVD.
Practice Address - Street 2:SUITE 3008
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3703
Practice Address - Country:US
Practice Address - Phone:904-810-2425
Practice Address - Fax:904-810-5321
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067870207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252004400Medicaid
FLG38265Medicare UPIN
FL252004400Medicaid
FL28882ZMedicare Oscar/Certification