Provider Demographics
NPI:1932431632
Name:ROBINSON, WILLIE EUGENE JR (IDC)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:EUGENE
Last Name:ROBINSON
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS OAK HILL
Mailing Address - Street 2:LSD 51
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09573-1739
Mailing Address - Country:US
Mailing Address - Phone:757-454-8051
Mailing Address - Fax:
Practice Address - Street 1:USS OAK HILL
Practice Address - Street 2:LSD 51
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09573-1739
Practice Address - Country:US
Practice Address - Phone:757-454-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman