Provider Demographics
NPI:1518028414
Name:ROBINSON, LISA ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1042 S 830 W
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6892
Mailing Address - Country:US
Mailing Address - Phone:435-571-1837
Mailing Address - Fax:
Practice Address - Street 1:1042 S 830 W
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6892
Practice Address - Country:US
Practice Address - Phone:435-571-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDR00008522084P0800X
WAOP000015212084P0800X
UT11862450-12042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518028414OtherNPI NUMBER