Healthcare Provider Details

I. General information

NPI: 1790781391
Provider Name (Legal Business Name): JEFFREY ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E DIXIE AVE
LEESBURG FL
34748-6014
US

IV. Provider business mailing address

802 E DIXIE AVE
LEESBURG FL
34748-6014
US

V. Phone/Fax

Practice location:
  • Phone: 352-787-1324
  • Fax:
Mailing address:
  • Phone: 352-787-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME35927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: