Provider Demographics
NPI:1255336418
Name:ROBBINS, KATHLEEN M (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1027
Mailing Address - Country:US
Mailing Address - Phone:573-761-7246
Mailing Address - Fax:573-761-6947
Practice Address - Street 1:2265 BAGNELL DAM BLVD
Practice Address - Street 2:STE 103
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-8603
Practice Address - Country:US
Practice Address - Phone:573-964-5599
Practice Address - Fax:573-365-6011
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000145060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205250301Medicaid
MO381331OtherHEALTHLINK
MO23129OtherHEALTHCARE USA
G48299Medicare UPIN
MO000090962Medicare ID - Type Unspecified