Provider Demographics
NPI: | 1003873670 |
---|---|
Name: | ROBINSON, GEORGE C (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | GEORGE |
Middle Name: | C |
Last Name: | ROBINSON |
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: | 100 MEDICAL CENTER DR |
Mailing Address - Street 2: | SUITE 205 |
Mailing Address - City: | GADSDEN |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35903-1134 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 256-456-0226 |
Mailing Address - Fax: | 256-456-0231 |
Practice Address - Street 1: | 100 MEDICAL CENTER DR |
Practice Address - Street 2: | SUITE 205 |
Practice Address - City: | GADSDEN |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35903-1134 |
Practice Address - Country: | US |
Practice Address - Phone: | 256-456-0226 |
Practice Address - Fax: | 256-456-0231 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-27 |
Last Update Date: | 2017-01-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AL | 15275 | 174400000X |
AL | MD.15275 | 208G00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AL | 193235 | Medicaid | |
AL | 193235 | Medicaid | |
AL | D07319 | Medicare UPIN |