Provider Demographics
NPI:1720206014
Name:ROBINSON, MARK NICHOLS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:NICHOLS
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10099 RIDGEGATE PKWY STE 480
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5537
Mailing Address - Country:US
Mailing Address - Phone:720-441-4021
Mailing Address - Fax:720-360-1195
Practice Address - Street 1:10099 RIDGEGATE PKWY STE 480
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5537
Practice Address - Country:US
Practice Address - Phone:720-599-3074
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0047531207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71771883Medicaid
CO71771883Medicaid