Provider Demographics
NPI:1356314140
Name:ROBINSON, MARK EDWARD (M D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36427-0648
Mailing Address - Country:US
Mailing Address - Phone:251-809-3160
Mailing Address - Fax:251-809-3165
Practice Address - Street 1:1121 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1505
Practice Address - Country:US
Practice Address - Phone:251-809-3160
Practice Address - Fax:251-809-3165
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000019710Medicaid
AL080015173Medicare PIN
AL000019710Medicaid
AL051019710ROBMedicare ID - Type Unspecified