Healthcare Provider Details

I. General information

NPI: 1023170420
Provider Name (Legal Business Name): RANDY R ROBINSON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 S 21ST ST
CLINTON IA
52732
US

IV. Provider business mailing address

PO BOX 361
CLINTON IA
52733-0361
US

V. Phone/Fax

Practice location:
  • Phone: 563-243-7200
  • Fax: 563-243-7201
Mailing address:
  • Phone: 563-242-5316
  • Fax: 563-242-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29686
License Number StateIA

VIII. Authorized Official

Name: RANDY R ROBINSON
Title or Position: OWNER
Credential: MD
Phone: 563-243-7200