Provider Demographics
NPI:1114928025
Name:ROBINSON, JEROME C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
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 1:802 AINSWORTH DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1623
Mailing Address - Country:US
Mailing Address - Phone:928-445-6025
Mailing Address - Fax:928-778-3026
Practice Address - Street 1:802 AINSWORTH DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1623
Practice Address - Country:US
Practice Address - Phone:928-445-6025
Practice Address - Fax:928-778-3026
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3888207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ218554Medicaid
AZP00126000OtherRAILROAD MEDICARE
AZWCSKQOtherSUN HEALTH GROUP #
AZD37524Medicare UPIN
AZZ78792Medicare PIN