Provider Demographics
NPI:1073598272
Name:ROBINSON, DAVID VANCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:VANCE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5174
Mailing Address - Country:US
Mailing Address - Phone:205-366-0032
Mailing Address - Fax:205-366-0610
Practice Address - Street 1:3515 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5174
Practice Address - Country:US
Practice Address - Phone:205-366-0032
Practice Address - Fax:205-366-0610
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL201213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000078635Medicare ID - Type Unspecified
5066560001Medicare NSC
ALU72541Medicare UPIN