Provider Demographics
NPI:1942339478
Name:ROBISON, ROSA H (M D)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:H
Last Name:ROBISON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5036 DR PHILLIPS BLVD
Mailing Address - Street 2:#315
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-3310
Mailing Address - Country:US
Mailing Address - Phone:407-286-2330
Mailing Address - Fax:407-523-0496
Practice Address - Street 1:2131 WESTOVER RESERVE BLVD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786
Practice Address - Country:US
Practice Address - Phone:407-286-2330
Practice Address - Fax:407-523-0496
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME612011223P0106X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057067200Medicaid
FLF12344Medicare UPIN
14401VMedicare PIN