MEDICARE: MATTHEW ROBISON DO

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	207V00000X	Obstetrics & Gynecology Physician	5101016745	MI
2	207V00000X	Obstetrics & Gynecology Physician	O-0646	ID

General Provider Information

NPI Number	:	1194757393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ROBISON DO

Provider Business Mailing Address
First Line	:	3450 POTOMAC WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7407
Country	:	US
Telephone Number	:	208-557-2900
Fax Number	:	208-557-2910

Provider Business Practice Location Address
First Line	:	3450 POTOMAC WAY
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7407
Country	:	US
Telephone Number	:	208-557-2900
Fax Number	:	208-557-2910

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	09/03/2015

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