Provider Demographics
NPI:1811974298
Name:ROBBINS, EARL GLEN II (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:GLEN
Last Name:ROBBINS
Suffix:II
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 1:3225 SUMMIT SQUARE PL STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2658
Mailing Address - Country:US
Mailing Address - Phone:859-266-7999
Mailing Address - Fax:859-269-6960
Practice Address - Street 1:3225 SUMMIT SQUARE PL STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2658
Practice Address - Country:US
Practice Address - Phone:859-266-7999
Practice Address - Fax:859-269-6960
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31908207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65923740OtherLEXINGTON CLINIC MEDICAID GROUP ID
KY0169OtherLEXINGTON CLINIC MCR GROUP ID
KY64319080Medicaid
KY000000052178OtherANTHEM PIN
KYK022190OtherMEDICARE PTAN
KY64319080Medicaid
KY0923201Medicare ID - Type Unspecified