Healthcare Provider Details

I. General information

NPI: 1447589353
Provider Name (Legal Business Name): JEROME A ROBSON M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COFFEE ROAD SUITE E
MODESTO CA
95355-4241
US

IV. Provider business mailing address

817 COFFEE RD BUILDING C3
MODESTO CA
95355-4241
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-1209
  • Fax: 209-521-1215
Mailing address:
  • Phone: 209-529-9603
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG32736
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG32736
License Number StateCA

VIII. Authorized Official

Name: JEROME ANTHONY ROBSON
Title or Position: PRESIDENT
Credential: MD
Phone: 209-529-9603