Provider Demographics
NPI:1497736326
Name:ROBINSON, RANDY R (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:R
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 1:282 CRAGMOR DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-1340
Mailing Address - Country:US
Mailing Address - Phone:563-243-5660
Mailing Address - Fax:
Practice Address - Street 1:2027 S 21ST STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732
Practice Address - Country:US
Practice Address - Phone:563-243-7200
Practice Address - Fax:563-243-7201
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA47260OtherBCBS IA
IA5105965Medicaid
229720OtherMIDLANDS CHOICE
IA47260OtherBCBS IA
IAI6446Medicare ID - Type Unspecified
IA5105965Medicaid