Healthcare Provider Details

I. General information

NPI: 1881517696
Provider Name (Legal Business Name): CLARENCE EDWARD ROBINSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4723 ALLEN ST
NEW ORLEANS LA
70122-3203
US

IV. Provider business mailing address

4723 ALLEN ST
NEW ORLEANS LA
70122-3203
US

V. Phone/Fax

Practice location:
  • Phone: 504-298-9281
  • Fax:
Mailing address:
  • Phone: 504-298-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH508043
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: