Provider Demographics
NPI:1891797429
Name:ROBBINS, MARK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:ROBBINS
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 1:1040 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2031
Mailing Address - Country:US
Mailing Address - Phone:903-533-8702
Mailing Address - Fax:903-533-8720
Practice Address - Street 1:1040 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2031
Practice Address - Country:US
Practice Address - Phone:903-533-8702
Practice Address - Fax:903-533-8720
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1987208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208617186OtherFEIN
TX752605101OtherFEIN
TX149737202Medicaid
TX4243569OtherBLUELINK
TX208617186OtherFEIN
TX4243569OtherBLUELINK