Provider Demographics
NPI:1326512633
Name:ROBINSON, PAUL ELLIOTT JR (BI)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ELLIOTT
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:BI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-0682
Mailing Address - Country:US
Mailing Address - Phone:803-682-5027
Mailing Address - Fax:803-531-3041
Practice Address - Street 1:815 WHITTAKER PKWY
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6248
Practice Address - Country:US
Practice Address - Phone:803-531-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33771744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management