Provider Demographics
NPI:1689614711
Name:MAIN, ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MAIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 SW 32ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4404
Mailing Address - Country:US
Mailing Address - Phone:352-282-0010
Mailing Address - Fax:352-496-3245
Practice Address - Street 1:3143 SW 32ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4404
Practice Address - Country:US
Practice Address - Phone:352-282-0010
Practice Address - Fax:352-496-3245
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102762363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292334300Medicaid