Provider Demographics
NPI:1790781391
Name:ROBINSON, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:ROBINSON
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 1:802 E DIXIE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6014
Mailing Address - Country:US
Mailing Address - Phone:352-787-1324
Mailing Address - Fax:
Practice Address - Street 1:802 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6014
Practice Address - Country:US
Practice Address - Phone:352-787-1324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
773114OtherMAILHANDLERS
7194953OtherMAMSI
P00397529OtherRR GBA MEDICARE
593516436OtherMEDICAL MUTUAL
593516436003OtherTRICARE
695956OtherTUFTS
FL35179OtherBCBS
7194953OtherMAMSI
35179XMedicare PIN