Provider Demographics
NPI:1255473286
Name:ROBINSON, RICKY LEON (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICKY
Middle Name:LEON
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 1:5145 MILLBRANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:MPHS
Mailing Address - State:TN
Mailing Address - Zip Code:38116
Mailing Address - Country:US
Mailing Address - Phone:901-332-1567
Mailing Address - Fax:901-332-1505
Practice Address - Street 1:5145 MILLBRANCH ROAD
Practice Address - Street 2:
Practice Address - City:MPHS
Practice Address - State:TN
Practice Address - Zip Code:38116
Practice Address - Country:US
Practice Address - Phone:901-332-1567
Practice Address - Fax:901-332-1505
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000420213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3351994Medicaid
TN3351994Medicare ID - Type Unspecified
TN3351994Medicaid