Provider Demographics
NPI:1659564581
Name:ROBINSON, BRIAN D (LMT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 ALVARADO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5102
Mailing Address - Country:US
Mailing Address - Phone:505-934-4190
Mailing Address - Fax:
Practice Address - Street 1:9601 SIERRA VISTA CT NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3422
Practice Address - Country:US
Practice Address - Phone:505-299-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist