Provider Demographics
NPI:1295712743
Name:ROBINSON, DENNIS EUGENE (DO)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:EUGENE
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 POMME DE TERRE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2386
Mailing Address - Country:US
Mailing Address - Phone:417-859-7875
Mailing Address - Fax:417-468-7978
Practice Address - Street 1:487 POMME DE TERRE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-2386
Practice Address - Country:US
Practice Address - Phone:417-859-7875
Practice Address - Fax:417-468-7978
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J93207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242648210Medicaid
MO000002429Medicare PIN
MO242648210Medicaid