Healthcare Provider Details

I. General information

NPI: 1841403441
Provider Name (Legal Business Name): BRYAN S ROBINSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E REDSTONE AVE
CRESTVIEW FL
32539-5358
US

IV. Provider business mailing address

127 E REDSTONE AVE
CRESTVIEW FL
32539-5358
US

V. Phone/Fax

Practice location:
  • Phone: 850-634-6464
  • Fax:
Mailing address:
  • Phone: 850-398-8725
  • Fax: 850-398-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO0000001829
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: