=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861633968
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L. BRIAN ROBINSON, DPM, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2009
-----------------------------------------------------
Last Update Date | 12/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1355 37TH ST SUITE 402
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-7321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-231-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1355 37TH ST SUITE 402
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-7321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-231-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MISS NANCY BUNKER
-----------------------------------------------------
Credential | C.P.C
-----------------------------------------------------
Telephone | 772-473-0787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO0002601
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------