Healthcare Provider Details

I. General information

NPI: 1710056577
Provider Name (Legal Business Name): STEVEN W ROBISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 POTOMAC WAY
IDAHO FALLS ID
83404-7407
US

IV. Provider business mailing address

3450 POTOMAC WAY
IDAHO FALLS ID
83404-7407
US

V. Phone/Fax

Practice location:
  • Phone: 208-557-2900
  • Fax: 208-557-2910
Mailing address:
  • Phone: 208-557-2900
  • Fax: 208-557-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberM9453
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: