Healthcare Provider Details

I. General information

NPI: 1225016694
Provider Name (Legal Business Name): DENNIS JAY ROBINSON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BERQUIST DRIVE SUITE 1 ATTN: CREDENTIALS (CMC)
LACKLAND AFB TX
78236-6300
US

IV. Provider business mailing address

2200 BERQUIST DRIVE SUITE 1 ATTN: CREDENTIALS (CMC)
LACKLAND AFB TX
78236-6300
US

V. Phone/Fax

Practice location:
  • Phone: 830-719-1943
  • Fax:
Mailing address:
  • Phone: 830-719-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05629
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: