Healthcare Provider Details

I. General information

NPI: 1205349875
Provider Name (Legal Business Name): REGINALD ROBINSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 DESHONG DR
PARIS TX
75460-9313
US

IV. Provider business mailing address

174 SAINT DONOVAN ST
FORT WORTH TX
76107-1252
US

V. Phone/Fax

Practice location:
  • Phone: 903-785-4521
  • Fax:
Mailing address:
  • Phone: 512-667-2219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11619
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: