Provider Demographics
NPI:1407871213
Name:PARK, ROBIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:S
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:777 CRAIG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7138
Mailing Address - Country:US
Mailing Address - Phone:314-991-1033
Mailing Address - Fax:314-991-1031
Practice Address - Street 1:777 CRAIG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7138
Practice Address - Country:US
Practice Address - Phone:314-991-1033
Practice Address - Fax:314-991-1031
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR3M292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203592506Medicaid
MO965605237Medicare UPIN