Provider Demographics
NPI:1932314788
Name:ROBINSON, TOMMY JOE JR (LO)
Entity Type:Individual
Prefix:
First Name:TOMMY
Middle Name:JOE
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S FM 51 # 109
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3645
Mailing Address - Country:US
Mailing Address - Phone:940-626-3722
Mailing Address - Fax:
Practice Address - Street 1:1705 S FM 51 # 109
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3645
Practice Address - Country:US
Practice Address - Phone:940-626-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1183OtherSTATE LICENSE