Provider Demographics
NPI:1588605117
Name:ROBINSON, MARY ELIZABETH LORES (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH LORES
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LORES
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:6701 AIRPORT BLVD
Mailing Address - Street 2:SUITE D-330
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6705
Mailing Address - Country:US
Mailing Address - Phone:251-607-9797
Mailing Address - Fax:251-607-9761
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2043
Practice Address - Country:US
Practice Address - Phone:251-990-9500
Practice Address - Fax:251-990-9501
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-208363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-90133OtherBLUE CROSS BLUE SHIELD
AL510-90133OtherBLUE CROSS BLUE SHIELD