MEDICARE: MICHAEL J ROBINSON MD

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	G59548	CA
2	207V00000X	Obstetrics & Gynecology Physician	M-10480	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G595480	OTHER	CA	MEDI CAL

General Provider Information

NPI Number	:	1275533184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J ROBINSON MD

Provider Business Mailing Address
First Line	:	315 ELM STREET
Second Line	:	STE 310
City	:	CALDWELL
State	:	ID
Zip	:	83605
Country	:	US
Telephone Number	:	208-454-2035
Fax Number	:	208-454-1065

Provider Business Practice Location Address
First Line	:	315 ELM STREET
Second Line	:	STE 310
City	:	CALDWELL
State	:	ID
Zip	:	83605
Country	:	US
Telephone Number	:	208-454-2035
Fax Number	:	208-454-1065

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	08/07/2014

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