Provider Demographics
NPI:1083715445
Name:ROBINSON, JOHN G (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95642
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0642
Mailing Address - Country:US
Mailing Address - Phone:801-253-9753
Mailing Address - Fax:801-253-9754
Practice Address - Street 1:5770 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6548
Practice Address - Country:US
Practice Address - Phone:801-314-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT146917-8905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD20157Medicare UPIN