Provider Demographics
NPI:1295769560
Name:ROBINSON, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
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:P.O. BOX 631914
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1914
Mailing Address - Country:US
Mailing Address - Phone:513-862-2601
Mailing Address - Fax:513-862-1190
Practice Address - Street 1:375 DIXMYTH AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2601
Practice Address - Fax:513-862-1190
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057778R208600000X, 208G00000X
KY26286208600000X, 208G00000X
ARR3552208600000X, 208G00000X
TXF1943208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0724363Medicaid
IN200046140Medicaid
310804060028OtherCARESOURCE
8330OtherKY BCBS
1820079OtherUNITED HEALTHCARE
3108040600D35OtherANTHEM
KY64262868Medicaid
K26286OtherCHOICE CARE/HUMANA
OH0724363Medicaid
KY64262868Medicaid
8330OtherKY BCBS
KY0677803Medicare ID - Type UnspecifiedKY MEDICARE
IN200046140Medicaid
3108040600D35OtherANTHEM