Provider Demographics
NPI:1679549828
Name:ROBSON, GREGORY BLAIR (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BLAIR
Last Name:ROBSON
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 1:2307 S HIGHWAY 53
Mailing Address - Street 2:P. O. BOX 247
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8568
Mailing Address - Country:US
Mailing Address - Phone:502-225-6277
Mailing Address - Fax:502-225-6278
Practice Address - Street 1:2307 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8568
Practice Address - Country:US
Practice Address - Phone:502-225-6277
Practice Address - Fax:502-225-6278
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY384802080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65934945Medicaid
KY0679104Medicare ID - Type Unspecified
KY65934945Medicaid