Provider Demographics
NPI:1386677417
Name:ROBSON, JEROME A (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:A
Last Name:ROBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COFFEE ROAD
Mailing Address - Street 2:C3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-529-9603
Mailing Address - Fax:209-529-6610
Practice Address - Street 1:500 COFFEE ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-521-1209
Practice Address - Fax:209-521-1215
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG32736207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G327360Medicare ID - Type Unspecified