Provider Demographics
NPI:1245342161
Name:ROBINSON, GORDON H (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:H
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11710 OLD BALLAS RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7076
Mailing Address - Country:US
Mailing Address - Phone:314-567-5000
Mailing Address - Fax:314-567-3110
Practice Address - Street 1:1170 OLD BALLAS ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-567-1958
Practice Address - Fax:314-567-0037
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD1002502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105460OtherBLUE CROSS BLUE SHIELD
MO229025OtherHEALTHLINK
MO260029804OtherRR MEDICARE
MO229025OtherHEALTHLINK
MO105460OtherBLUE CROSS BLUE SHIELD