Provider Demographics
NPI:1124552146
Name:DOUGLAS ROBINSON DPM PROFESSIONAL PODIATRY CORPORATION
Entity Type:Organization
Organization Name:DOUGLAS ROBINSON DPM PROFESSIONAL PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:408-370-3351
Mailing Address - Street 1:131 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0234
Mailing Address - Country:US
Mailing Address - Phone:408-489-3414
Mailing Address - Fax:
Practice Address - Street 1:131 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0234
Practice Address - Country:US
Practice Address - Phone:408-370-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3549213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE35490Medicare UPIN