Healthcare Provider Details

I. General information

NPI: 1194872150
Provider Name (Legal Business Name): DENNIS E. ROBINSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 POMME DE TERRE
MARSHFIELD MO
65706-2386
US

IV. Provider business mailing address

487 POMME DE TERRE P O BOX 736
MARSHFIELD MO
65706-2386
US

V. Phone/Fax

Practice location:
  • Phone: 417-859-7875
  • Fax: 417-468-7978
Mailing address:
  • Phone: 417-859-7875
  • Fax: 417-468-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7J93
License Number StateMO

VIII. Authorized Official

Name: DR. DENNIS EUGENE ROBINSON
Title or Position: PHYSICIAN OWNER
Credential: D.O.
Phone: 417-859-7875