Provider Demographics
NPI:1083610083
Name:ROBINSON, JAY GORDON (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:GORDON
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 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 1235
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-472-5157
Mailing Address - Fax:816-472-7201
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 1235
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-472-5157
Practice Address - Fax:816-472-7201
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-03-17
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
MOR8F092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1083610083Medicaid
MO130012717OtherRR MEDICARE PROVIDER ID
MO12600064OtherBCBS PROVIDER ID
MO12600064OtherBCBS PROVIDER ID
MOMA4872006Medicare UPIN