Provider Demographics
NPI:1831120583
Name:TERRY E. ROBINSON, M.D., LLC
Entity Type:Organization
Organization Name:TERRY E. ROBINSON, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-776-3937
Mailing Address - Street 1:6807 CHENEY CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7239
Mailing Address - Country:US
Mailing Address - Phone:303-652-3846
Mailing Address - Fax:
Practice Address - Street 1:521 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8503
Practice Address - Country:US
Practice Address - Phone:303-776-3937
Practice Address - Fax:303-776-8760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25327305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAR9256579OtherDEA REGISTRATION NUMBER
COAR9256579OtherDEA REGISTRATION NUMBER
COE70698Medicare UPIN