Healthcare Provider Details

I. General information

NPI: 1174938237
Provider Name (Legal Business Name): JEREMY ROBBINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 2508
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

DEPARTMENT OF ANESTHESIOLOGY ONE HOSPITAL DRIVE, DC005.00
COLUMBIA MO
65212-0001
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6999
  • Fax:
Mailing address:
  • Phone: 573-882-2568
  • Fax: 573-882-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2014021211
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0060105
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: