Provider Demographics
NPI:1053384842
Name:ROBINSON, STEPHEN A (M D)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-3521
Mailing Address - Country:US
Mailing Address - Phone:956-689-5506
Mailing Address - Fax:956-689-1988
Practice Address - Street 1:165 S 6TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3521
Practice Address - Country:US
Practice Address - Phone:956-689-5506
Practice Address - Fax:956-689-1988
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8288207Q00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062QROtherBCBS OF TEXAS
TX193437401Medicaid
TX0062QROtherBCBS TX
TX6441090001Medicare NSC
TX613274Medicare PIN
TXIO9244Medicare UPIN
TXP00657451Medicare PIN
TXTXB102663Medicare PIN