Healthcare Provider Details

I. General information

NPI: 1316918006
Provider Name (Legal Business Name): JEFFREY D ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S VAN DYKE RD STE 3
BAD AXE MI
48413
US

IV. Provider business mailing address

1040 S VAN DYKE RD SUITE 3
BAD AXE MI
48413-9646
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9855
  • Fax: 989-269-4097
Mailing address:
  • Phone: 989-269-9855
  • Fax: 989-269-4097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301052941
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberJR052941
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: