Provider Demographics
NPI:1447390067
Name:ROBINSON, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
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 1:14069 MARQUESAS WAY
Mailing Address - Street 2:SUITE 216D
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6052
Mailing Address - Country:US
Mailing Address - Phone:310-301-3031
Mailing Address - Fax:310-301-3001
Practice Address - Street 1:14069 MARQUESAS WAY
Practice Address - Street 2:SUITE 216D
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6052
Practice Address - Country:US
Practice Address - Phone:310-301-3031
Practice Address - Fax:310-301-3001
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG72600208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G726000Medicaid
CA00G726000OtherBLUE CROSS BLUE SHIELD
CA00G726000Medicaid
CA00G726000OtherBLUE CROSS BLUE SHIELD