Healthcare Provider Details

I. General information

NPI: 1629184668
Provider Name (Legal Business Name): CHRISTINA AUDELL ROBINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S NEW BALLAS RD SUITE 100E
SAINT LOUIS MO
63141-8705
US

IV. Provider business mailing address

777 S NEW BALLAS RD SUITE 100E
SAINT LOUIS MO
63141-8705
US

V. Phone/Fax

Practice location:
  • Phone: 314-475-3126
  • Fax: 314-475-3127
Mailing address:
  • Phone: 314-475-3126
  • Fax: 314-475-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000171136
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: