Provider Demographics
NPI:1568404622
Name:ROBINSON, BRENT WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:WILLIAM
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:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:2604 SAINT MICHAEL DR STE 345
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2378
Practice Address - Country:US
Practice Address - Phone:903-838-5500
Practice Address - Fax:903-838-7402
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0175207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100147780AMedicaid
AR97560OtherBCBS OF ARKANSAS
TX0005940447OtherAETNA
AR131289001Medicaid
AR173320000OtherQUAL CHOICE
TX3390657OtherBLUE LINK
TX045226001Medicaid
TX86V156OtherBCBS OF TEXAS
AR173320000OtherQUAL CHOICE
AR131289001Medicaid