Provider Demographics
NPI:1447589353
Name:JEROME A ROBSON M D INC
Entity Type:Organization
Organization Name:JEROME A ROBSON M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ROBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-529-9603
Mailing Address - Street 1:817 COFFEE RD
Mailing Address - Street 2:BUILDING C3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4241
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32736207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG327360Medicaid
CAOOG327360Medicaid
CAOOG327360Medicare PIN