Healthcare Provider Details

I. General information

NPI: 1730475005
Provider Name (Legal Business Name): JONATHAN ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 6A/6B/12A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8233
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2500
  • Fax: 314-747-2598
Mailing address:
  • Phone: 314-747-2500
  • Fax: 314-747-2598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2018009646
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2018009646
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: