MEDICARE: ROBISON CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2832	OK

General Provider Information

NPI Number	:	1568596583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBISON CLINIC

Provider Business Mailing Address
First Line	:	1415 WATTS ST
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1310
Country	:	US
Telephone Number	:	580-928-2044
Fax Number	:	580-928-5660

Provider Business Practice Location Address
First Line	:	1415 WATTS ST
Second Line	:
City	:	SAYRE
State	:	OK
Zip	:	73662-1310
Country	:	US
Telephone Number	:	580-928-2044
Fax Number	:	580-928-5660

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MELVIN L ROBISON
Credential	:	D.O.
Telephone Number	:	580-928-2044

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	03/17/2008

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