Healthcare Provider Details

I. General information

NPI: 1245456375
Provider Name (Legal Business Name): MARK ROBBINS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S FLEISHEL AVE STE 1
TYLER TX
75701-2031
US

IV. Provider business mailing address

1040 S FLEISHEL AVE STE 1
TYLER TX
75701-2031
US

V. Phone/Fax

Practice location:
  • Phone: 903-533-8702
  • Fax: 903-533-8720
Mailing address:
  • Phone: 903-533-8702
  • Fax: 903-533-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. MARK R ROBBINS
Title or Position: OWNER
Credential: M,D.
Phone: 903-533-8702