Provider Demographics
NPI:1003999715
Name:ROBINSON, RUSSELL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:L
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 1:1926 VICTORIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-3414
Mailing Address - Country:US
Mailing Address - Phone:239-344-3291
Mailing Address - Fax:
Practice Address - Street 1:316 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1710
Practice Address - Country:US
Practice Address - Phone:239-314-1616
Practice Address - Fax:239-479-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008996700Medicaid
FL008996700Medicaid
SC57-0943668OtherFEDERAL TAX ID #