Healthcare Provider Details

I. General information

NPI: 1184604480
Provider Name (Legal Business Name): LAWRENCE GEORGE ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
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 TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME0057471
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0057471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: