Healthcare Provider Details

I. General information

NPI: 1245342161
Provider Name (Legal Business Name): GORDON H. ROBINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 OLD BALLAS ROAD SUITE 110
ST. LOUIS MO
63141
US

IV. Provider business mailing address

11710 OLD BALLAS RD STE 110
CREVE COEUR MO
63141-7076
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1958
  • Fax: 314-567-0037
Mailing address:
  • Phone: 314-567-5000
  • Fax: 314-567-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD100250
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: