MEDICARE: MR. DAVID BRADLEY ROBBINS PA-C, ATC

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	363AS0400X	Surgical Physician Assistant	PA00155	MS

General Provider Information

NPI Number	:	1144293655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID BRADLEY ROBBINS PA-C, ATC

Provider Business Mailing Address
First Line	:	206 OXFORD RD
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3115
Country	:	US
Telephone Number	:	662-534-2227
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 OXFORD RD
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3115
Country	:	US
Telephone Number	:	662-534-2227
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	03/04/2014

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