Provider Demographics
NPI:1962485805
Name:ROBINSON, JASON DARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DARREN
Last Name:ROBINSON
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 1:1913 WIND LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-1170
Mailing Address - Country:US
Mailing Address - Phone:214-454-6641
Mailing Address - Fax:972-272-1240
Practice Address - Street 1:1913 WIND LAKE CIR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-1170
Practice Address - Country:US
Practice Address - Phone:214-454-6641
Practice Address - Fax:972-272-1240
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1627640Medicaid
LAI 37191Medicare UPIN
LA1627640Medicaid