Provider Demographics
NPI:1598772956
Name:ROBINSON, MICHAEL FRED (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRED
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 1:1304 LARCHMONT LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73116-6114
Mailing Address - Country:US
Mailing Address - Phone:405-848-5258
Mailing Address - Fax:
Practice Address - Street 1:1304 LARCHMONT LN
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73116-6114
Practice Address - Country:US
Practice Address - Phone:405-848-5258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12277207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100088670BMedicaid
OK100088670AMedicaid
D42760Medicare UPIN
OK100088670BMedicaid