Provider Demographics
NPI:1689442501
Name:ROBINSON, SAMUEL L
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 W SOUTH JORDAN PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8524
Mailing Address - Country:US
Mailing Address - Phone:801-302-2690
Mailing Address - Fax:801-302-2693
Practice Address - Street 1:661 W SOUTH JORDAN PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8524
Practice Address - Country:US
Practice Address - Phone:801-302-2690
Practice Address - Fax:801-302-2693
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14208626-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical