Provider Demographics
NPI:1841403441
Name:ROBINSON, BRYAN S (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:S
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E REDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5348
Mailing Address - Country:US
Mailing Address - Phone:850-398-8725
Mailing Address - Fax:850-398-8727
Practice Address - Street 1:202 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4566
Practice Address - Country:US
Practice Address - Phone:931-363-4543
Practice Address - Fax:931-363-4523
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001829208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics