Healthcare Provider Details

I. General information

NPI: 1700823176
Provider Name (Legal Business Name): ROBERT L. ROBBINS, D.O., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST
CHARLESTON MO
63834-1644
US

IV. Provider business mailing address

400 S MAIN ST
CHARLESTON MO
63834-1644
US

V. Phone/Fax

Practice location:
  • Phone: 573-683-3739
  • Fax: 573-683-4956
Mailing address:
  • Phone: 573-683-3739
  • Fax: 573-683-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31640
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116998
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT L. ROBBINS JR.
Title or Position: OWNER/PHYSICIAN
Credential: D.O.
Phone: 573-683-3739