Healthcare Provider Details

I. General information

NPI: 1366362527
Provider Name (Legal Business Name): MR. MARK A ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 S 96TH ST
OMAHA NE
68127-1221
US

IV. Provider business mailing address

4205 S 96TH ST
OMAHA NE
68127-1221
US

V. Phone/Fax

Practice location:
  • Phone: 531-466-1275
  • Fax:
Mailing address:
  • Phone: 531-466-1275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: