Provider Demographics
NPI:1699815217
Name:PAUL M ROBINSON MD
Entity Type:Organization
Organization Name:PAUL M ROBINSON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-3031
Mailing Address - Street 1:485 BROADWAY ST
Mailing Address - Street 2:SUITE # D
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2451
Mailing Address - Country:US
Mailing Address - Phone:310-301-3031
Mailing Address - Fax:310-301-3001
Practice Address - Street 1:485 BROADWAY STREET
Practice Address - Street 2:SUITE # D
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:310-301-3031
Practice Address - Fax:310-301-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72600208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G726000Medicaid
CA00G726000OtherBLUECROSS BLUE SHIELD
CAG72600AMedicare ID - Type Unspecified
CAF64414Medicare UPIN