Provider Demographics
NPI:1649380080
Name:ROBINSON, DAVID DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DANIEL
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:D
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1811 GRAND CANAL BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8107
Mailing Address - Country:US
Mailing Address - Phone:209-475-0309
Mailing Address - Fax:209-475-0387
Practice Address - Street 1:1244 HEIDELBERG WAY
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9131
Practice Address - Country:US
Practice Address - Phone:209-339-4577
Practice Address - Fax:209-263-7278
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A62022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A62020Medicaid
CA020A62020Medicaid
G16551Medicare UPIN