Provider Demographics
NPI:1346460813
Name:ROBINS, MELVIN MORENO (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:MORENO
Last Name:ROBINS
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 1:3373 N 175 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4506
Mailing Address - Country:US
Mailing Address - Phone:801-373-0654
Mailing Address - Fax:801-377-6811
Practice Address - Street 1:1355 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2721
Practice Address - Country:US
Practice Address - Phone:801-373-8930
Practice Address - Fax:801-377-6811
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1463061205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG44000Medicare UPIN
UT5545708Medicare ID - Type Unspecified