Healthcare Provider Details

I. General information

NPI: 1376711622
Provider Name (Legal Business Name): LAWRENCE G ROBINSON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EXECUTIVE LN SUITE 120
ROCKLEDGE FL
32955-3595
US

IV. Provider business mailing address

830 EXECUTIVE LN SUITE 120
ROCKLEDGE FL
32955-3595
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-2551
  • Fax: 321-504-6260
Mailing address:
  • Phone: 321-639-2551
  • Fax: 321-504-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0057471
License Number StateFL

VIII. Authorized Official

Name: LAWRENCE GEORGE ROBINSON
Title or Position: PHYSICIAN
Credential:
Phone: 321-639-2551