Provider Demographics
NPI:1518695642
Name:ROBINSON, ROMA K
Entity Type:Individual
Prefix:
First Name:ROMA
Middle Name:K
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 HIDDEN OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-4109
Mailing Address - Country:US
Mailing Address - Phone:469-474-9575
Mailing Address - Fax:
Practice Address - Street 1:267 HIDDEN OAKS TRL
Practice Address - Street 2:
Practice Address - City:POTTSBORO
Practice Address - State:TX
Practice Address - Zip Code:75076-4109
Practice Address - Country:US
Practice Address - Phone:469-474-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty