Provider Demographics
NPI:1407828015
Name:ROBINSON, KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:ROBINSON
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 1:1164 E OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-2707
Mailing Address - Country:US
Mailing Address - Phone:954-900-5635
Mailing Address - Fax:954-990-7292
Practice Address - Street 1:1164 E OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-2707
Practice Address - Country:US
Practice Address - Phone:954-900-5635
Practice Address - Fax:954-990-7292
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83200207RC0200X, 207RP1001X
FLME86367207RC0200X
FLME 86367207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276264100Medicaid
CG458AMedicare PIN