Provider Demographics
NPI:1871662452
Name:ROBINSON, ROBERT FARRIS JR (CCA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FARRIS
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BAY SHORE LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3175
Mailing Address - Country:US
Mailing Address - Phone:757-484-1167
Mailing Address - Fax:
Practice Address - Street 1:3005 BAY SHORE LANE
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3175
Practice Address - Country:US
Practice Address - Phone:757-582-4063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist