MEDICARE: BRADLEY D. ROBISON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	112616	MO
2	2084P0804X	Child & Adolescent Psychiatry Physician	112616	MO

General Provider Information

NPI Number	:	1093931644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY D. ROBISON M.D.

Provider Business Mailing Address
First Line	:	2238 COUNTY ROAD 262
Second Line	:
City	:	ADVANCE
State	:	MO
Zip	:	63730-9027
Country	:	US
Telephone Number	:	573-722-5261
Fax Number	:	573-722-3650

Provider Business Practice Location Address
First Line	:	106 FARRAR DR
Second Line	:	SUITE 109
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4902
Country	:	US
Telephone Number	:	573-334-7055
Fax Number	:	573-334-7961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	10/31/2011

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