Provider Demographics
NPI:1689679300
Name:ROBISON, JAMES BRYAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRYAN
Last Name:ROBISON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 N KNOLL RD
Mailing Address - Street 2:STE 3
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1665
Mailing Address - Country:US
Mailing Address - Phone:415-388-2777
Mailing Address - Fax:415-388-2778
Practice Address - Street 1:7 N KNOLL RD
Practice Address - Street 2:STE 3
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1665
Practice Address - Country:US
Practice Address - Phone:415-388-2777
Practice Address - Fax:415-388-2778
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3740213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU16507Medicare UPIN
CA000E37400Medicare PIN
CA4911160001Medicare NSC